Abstract
Fibrinolysis is normally regulated by many activators and inhibitors, in a step-wise sequence. This regulation limits the fibrinolytic process on the blood clot and prevents its systemic dissemination. Specific clinical situations may be followed by an overwhelming primary fibrinolytic process: amniotic fluid embolism, anaphylactic shock and snake bites. In these cases, defibrination is caused by direct proteolysis of plasma fibrinogen. In the most frequent cases, exaggerated fibrinolysis is due to an early activation of plasma and endothelial coagulation. The fibrinolytic process may induce a severe haemorrhagic syndrome in the early post-partum period and in severe liver failure. In these cases, treament with antifibrinolytics must use aprotinin or tranexamic acid to counteract plasmin generation and effects.
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