Abstract
The processes of thrombosis and coagulation are finely regulated by endogenous fibrinolysis maintaining healthy equilibrium. When the balance is altered in favour of platelet activation and/or coagulation, or if endogenous fibrinolysis becomes less efficient, pathological thrombosis can occur. Arterial thrombosis remains a major cause of morbidity and mortality in the world despite advances in medical therapies. The role endogenous fibrinolysis in the pathogenesis of arterial thrombosis has gained increasing attention in recent years as it presents novel ways to prevent and treat existing diseases. In this review article, we discuss the role of endogenous fibrinolysis in platelet thrombus formation, methods of measurement of fibrinolytic activity, its role in predicting cardiovascular diseases and clinical outcomes and future directions.
Highlights
Haemostasis is a complex sequence of biochemical response to injury to allow formation of a blood clot and repair of damaged endothelium
Emphasis has been placed on thin-cap fibroatheroma (TCFA) as they are considered very vulnerable to rupture and are most causally associated with the occurrence of coronary thrombosis [6]
Hyperfibrinolysis can result in uncontrolled bleeding, as in the case with disseminated intravascular coagulation (DIC) where systemic inflammation causes increased consumption of fibrin and clotting factors
Summary
Haemostasis is a complex sequence of biochemical response to injury to allow formation of a blood clot and repair of damaged endothelium. The maintenance of the equilibrium between coagulation and fibrinolysis is vital, as imbalance would lead to abnormal bleeding or increased risk of thrombosis. Thrombosis is pathological clot formation within the blood vessels in the absence of injury. The recognition of thrombosis has shaped treatment and prevention of vascular events such as acute coronary syndrome (ACS), which is typically caused by arterial thrombosis following the rupture of vulnerable atheroma within the arterial wall [1,2,3]
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