Perioperative hyperfibrinolysis – physiology and pathophysiology

Marinho, David Silveira

doi:10.1016/j.bjane.2020.12.007

Cited by 11 publications

(12 citation statements)

References 47 publications

(47 reference statements)

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“…Una sua classificazione propone una suddivisione in: fibrinolisi fisiologica (che non causa un sanguinamento eccessivo) e iperfibrinolisi (che causa un sanguinamento © 2022 The Authors. AboutOpen -ISSN 2465-2628 -www.aboutscience.eu/aboutopen eccessivo); quest'ultima, a sua volta, può essere suddivisa in fibrinolisi locale (primaria) e iperfibrinolisi sistemica (primaria o secondaria) (7). L'iperfibrinolisi primaria sistemica si manifesta in situazioni di squilibrio tra attivatori e inibitori del sistema fibrinolitico, generando un'attività fibrinolitica eccessiva e non correlata a un'iperattività del sistema coagulativo (p.…”

Section: La Fibrinolisiunclassified

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Coagulopathy and hemorrhage management in major abdominal surgery

Piangatelli¹

2022

abtpn

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Whilst some guidelines for hemorrhage management during major abdominal surgery have been written, evaluation of the patient’s basal condition remains the headmost factor. Firstly, an assessment to predict perioperative bleeding should be performed, although its prognostic ability is limited as it relies on the patient’s anamnesis and on standardized tests that can have a low predictive accuracy. Upon hemorrhage, monitoring the therapeutic window between hypovolemia and hypervolemia is of crucial importance. According to the guidelines, both a prompt stabilization of cardiac preload and goal-directed fluid therapy (with either colloids or crystalloids) are advised in case of both hypovolemia and hypervolemia. Plasma transfusion, instead, is discouraged for treatment of elevated (mild to moderate) International normalized ratio (INR), as it was shown to have minimal effects and increase the risk of infection. In summary, to define the weak link in the coagulation cascade and the etiopathogenesis of postoperative bleeding is necessary to rely on all available methodologies, such as standardized tests, Point-of-care tests and goal-directed therapies. This review gives an overview of the many factors that are to be monitored during surgical hemorrhage and a summary of the approaches to manage coagulopathy.

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Section: La Fibrinolisiunclassified

“…È causata dalla manipolazione chirurgica o traumatica dei tessuti ricchi di attivatori fibrinolitici (p. es., t-PA e u-PA), che porta al rilascio locale di queste sostanze (7).…”

Section: La Fibrinolisiunclassified

Coagulopathy and hemorrhage management in major abdominal surgery

Piangatelli¹

2022

abtpn

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“…Em seguida, ocorre a hemostasia secundária que é responsável pela ativação dos fatores de coagulação e trombina, com consequente transformação do fibrinogênio em fibrina. A cascata da coagulação é finalizada com a fibrinólise do trombo formado e, ocorre o retorno a hemostasia fisiológica (Marinho, 2021).…”

Section: Fonte: Autoresunclassified

COVID-19: Compreendendo a “tempestade de citocinas”

Napoleão

Santiago

Moreira

et al. 2021

RSD

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O SARS-CoV-2 espalhou-se rapidamente pela China e logo recebeu atenção mundial, levando a Organização Mundial da Saúde (OMS) a declarar, em 30 de janeiro de 2020, a infecção pelo SARS-CoV-2 como emergência de saúde pública de interesse internacional. Trata-se de uma revisão de literatura que objetiva atualizar e ampliar as informações disponíveis acerca do SARS-CoV-2, abrangendo a resposta imune contra ele e a consequente formação da tempestade de citocinas. Em alguns indivíduos, a resposta exacerbada do sistema imunológico provoca a hiperestimulação de suas células de defesa, causando uma hiperinflamação em decorrência da tempestade de citocinas pró-inflamatórias (TNF-α, IL-1-β, IL-6, IL-12 e quimiocinas). Essa hiperinflamação caracteriza a fisiopatologia da COVID-19 grave que provoca alterações patológicas principalmente nos pulmões, sendo um fator preditor de gravidade da doença devido à forte associação com a falência de múltiplos órgãos, podendo levar à morte. A dosagem dos níveis séricos de IL-6 e IL-10 foram considerados preditores da gravidade da doença e pode ser usada para o diagnóstico de pacientes com maior risco de agravamento da doença. Conclui-se que elevações dos níveis séricos de citocinas pró-inflamatórias geralmente estão presentes na COVID-19 grave. Porém, mais estudos são necessários para estabelecer diferenças entre os pacientes com COVID-19 que desenvolvem reação inflamatória protetora e equilibrada daqueles que desenvolvem reação inflamatória exagerada, com consequente tempestade patológica de citocinas.

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“…Under pathological conditions associated with a pro-coagulant state, impaired fibrinolysis becomes an additional risk factor of thrombosis [ 12 , 13 ]. On the other hand, an increased activity of the fibrinolytic system is a risk of uncontrolled bleedings associated with different surgical procedures [ 14 , 15 ]. Antifibrinolytics are used in patients with von Willebrand disease [ 16 ] and to treat thrombolytic-induced bleedings [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Plant-Derived Compounds and Extracts as Modulators of Plasmin Activity—A Review

Kołodziejczyk-Czepas

Czepas

2023

Molecules

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Functionality of the fibrinolytic system is based on activity of its central enzyme, plasmin, responsible for the removal of fibrin clots. Besides the hemostasis, fibrinolytic proteins are also involved in many other physiological and pathological processes, including immune response, extracellular matrix degradation, cell migration, and tissue remodeling. Both the impaired and enhanced activity of fibrinolytic proteins may result in serious physiological consequences: prothrombotic state or excessive bleeding, respectively. However, current medicine offers very few options for treating fibrinolytic disorders, particularly in the case of plasmin inhibition. Although numerous attempts have been undertaken to identify natural or to develop engineered fibrinolytic system modulators, structural similarities within serine proteases of the hemostatic system and pleiotropic activity of fibrinolytic proteins constitute a serious problem in discovering anti- or profibrinolytic agents that could precisely affect the target molecules and reduce the risk of side effects. Therefore, this review aims to present a current knowledge of various classes of natural inhibitors and stimulators of the fibrinolytic system being well-defined low-molecular plant secondary metabolites or constituents of plant extracts as well as plant peptides. This work also discusses obstacles caused by low specificity of most of natural compounds and, hence, outlines recent trends in studies aimed at finding more efficient modulators of plasmin activity, including investigation of modifications of natural pharmacophore templates.

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Perioperative hyperfibrinolysis – physiology and pathophysiology

Cited by 11 publications

References 47 publications

Coagulopathy and hemorrhage management in major abdominal surgery

Coagulopathy and hemorrhage management in major abdominal surgery

COVID-19: Compreendendo a “tempestade de citocinas”

Plant-Derived Compounds and Extracts as Modulators of Plasmin Activity—A Review

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