The Fibrinolytic System—More Than Fibrinolysis?

Abstract The fibrinolytic system, known for its ability to regulate the activation of the zymogen plasminogen into active plasmin, has been primarily associated with the removal of fibrin and blood clots. Tissue-type plasminogen activator, the most well-recognized plasminogen activator, was harnesse...

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Bibliographic Details
Published in:Transfusion medicine reviews 2015-04, Vol.29 (2), p.102-109
Main Authors: Draxler, Dominik F, Medcalf, Robert L
Format: Article
Language:English
Subjects:
Animals
Central Nervous System - physiology
Fibrinolysin - physiology
Fibrinolysis
Fibrinolysis - physiology
Hematology, Oncology and Palliative Medicine
Hemorrhage - drug therapy
Hemorrhage - prevention & control
Humans
Inflammation Mediators - metabolism
Mice
Nerve Tissue Proteins - physiology
Neuronal Plasticity - physiology
Neuroprotective Agents - pharmacology
Neurotoxins - pharmacology
Plasmin
Plasminogen activation
Randomized Controlled Trials as Topic
Receptors, N-Methyl-D-Aspartate - physiology
t-PA
Tissue Plasminogen Activator - pharmacology
Tissue Plasminogen Activator - physiology
Tissue Plasminogen Activator - toxicity
Tranexamic acid
Tranexamic Acid - adverse effects
Tranexamic Acid - pharmacology
Tranexamic Acid - therapeutic use
Wound Healing - drug effects
Wound Healing - physiology
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Summary:Abstract The fibrinolytic system, known for its ability to regulate the activation of the zymogen plasminogen into active plasmin, has been primarily associated with the removal of fibrin and blood clots. Tissue-type plasminogen activator, the most well-recognized plasminogen activator, was harnessed for therapeutic benefit against thromboembolic disorders more than 30 years ago, whereas inhibition of this system has been proven effective for certain bleeding disorders. However, in recent years, new and unexpected functional roles for this system have been identified mostly in relation to the central nervous system that are both unrelated and independent of fibrin degradation and clot removal. Hence, it seems reasonable to ask whether agents used to modify components or activities of the fibrinolytic system have any clinical consequences unrelated to their intended use in hemostasis. This review will provide an overview of these new features of the fibrinolytic system and will also focus on prospective considerations in the use of fibrinolytic and antifibrinolytic agents.
ISSN:0887-7963
1532-9496
DOI:10.1016/j.tmrv.2014.09.006