Evolving Paradigms in Laboratory Biomarkers of Fibrinolysis Phenotypes and Association with Post-Traumatic Vascular Thrombosis

Abstract

Traumatic tissue injury triggers blood coagulation to stanch bleeding and concomitant blood clot lysis to restore vascular patency. Approximately, 40% of trauma cases potentially present with trauma-induced coagulopathy that may coexist with clot dissolution or fibrinolysis. Laboratory test results of fibrinolysis biomarkers stratify fibrinolytic phenotypes into hyperfibrinolysis, physiological, hypofibrinolysis, and fibrinolytic shutdown. However, often, there is incongruence between laboratory findings and clinical presentation of bleeding or vascular thrombosis. Increasingly, it is becoming clear that laboratory findings transiently depend on the timing of blood sampling. The spectrum of evolving fibrinolysis phenotypes, a component of nature’s adaptation to wound healing that ranges from initial promotion of blood fluidity to subsequent thrombosis, presents a clinical diagnostic dilemma with regard to the timing of antifibrinolytics or anticoagulants intervention. This chapter will review the available literature on post-traumatic fibrinolytic phenotypes, diagnostic challenges, evolution over time, clinical outcomes following therapeutic interventions, and association with vascular thrombosis.