Prognostic Value of Plasma Fibrinolysis Activation Markers in Cardiovascular Disease

Abstract

The pivotal role of hypoactive endogenous fibrinolysis in the occurrence of thrombotic cardiovascular events is now well-recognized. To evaluate the diagnostic and prognostic role of impaired fibrinolysis, plasma fibrinolysis markers have been investigated in large prospective studies in both healthy individuals and patients with established coronary disease. Antigen and activity levels of components of the fibrinolytic system were measured by immunoassays, which replaced earlier global fibrinolysis tests. This review covers 45 studies in nearly 50,000 subjects, examining the association between plasma markers of fibrinolysis and coronary artery disease, to establish the usefulness of these markers in predicting future cardiovascular events. The predictive value of plasma levels of tissue-type plasminogen activator, platelet activator inhibitor-1, plasmin-antiplasmin complex, D-dimer, thrombin activatable fibrinolysis inhibitor, and lipoprotein(a) for major adverse cardiac events is highly variable and conflicting, especially after adjusting for conventional risk factors, judging from the published data in the last decade. The value of fibrinolysis activity markers is very limited in aiding diagnosis and risk stratification in the individual patient, on the basis of the weak prognostic values obtained in some studies and the lack of power in others. The physiological limitations of such markers in reflecting endogenous fibrinolysis is discussed. The emerging novel global assays of fibrinolysis will require large-scale clinical trials before their prognostic power or superiority to multiple biomarker measurements can be evaluated.

Fibrinolytic Activity of Blood and its Determinants in Healthy Medical Students

“…Various observational studies in the past have found that vegetarian diets increases the fibrinolytic activity and decreases the thrombogenic potential of blood by decreasing PAI-1, factor VII, and blood viscosity [4,10].On data analysis of present study we did not find any significant difference in fibrinolytic activity between lactovegetarian and semi-vegetarian groups [Table/ Fig-2]. This might be due to lack of representative population of different dietary classes in our study sample.…”

“…This is found to be well correlated with proneness towards stroke, IHD, thrombo-embolic diseases and is an independent predictor of both fatal and nonfatal IHD [4][5][6]. Thus assessment of fibrinolysis time is one of the most important markers of cardiovascular health [7].…”

“…Fibrinolysis time is the time required for lysis of clot in circulation [4]. The process is completed within 2-4 hours with a reference range of 90 minutes to 6 hours [8].…”

“…Longer fibrinolysis time indicates poor fibrinolytic activity and propensity for thrombus formation in the circulation [4]. A delicate balance is required between procoagulants and fibrinolytic system for normal haemostasis [4].…”

The overview of brinolysis system contemporary concepts and of its disorders diagnostic methods

“…Отдельные белки могут принимать участи во всех процессах, обеспечивая взаимную регуля-цию различных этапов свертывания. В данном обзоре мы остановимся на функционировании и регуляции финального этапа существования тромба -фибри-нолизе.Нарушения в системе фибринолиза могут быть связаны с увеличением риска развития венозного тромбоза [1], но не во всех работах такая закономер-ность была обнаружена [2]. В ряде случаев, таких как инфаркт миокарда, тромбоз глубоких вен, легочная эмболия, инсульт, возникает необходимость экстрен-ного удаления тромба, препятствующего кровотоку.…”