Hyperfibrinolysis

Hyperfibrinolysis

David Ray Velez, MD

Table of Contents

Definitions
Secondary Causes
Diagnosis
Treatment

Definitions

Definition: Excessive Clot Breakdown

Classification

  • Primary Fibrinolysis: Breakdown of Clot Due to Excessive Production of Plasminogen Activator or Decreased Production of Fibrinolysis Inhibitors
  • Secondary Fibrinolysis: Excessive Clot Breakdown Due to Secondary Causes

Secondary Causes

Secondary Causes

  • Fibrinolytic Medications (tPA) – May Be Therapeutic
  • Trauma
  • Cancer
  • Sepsis
  • Can Be a Component of DIC
  • Cirrhosis – Decreased tPA Clearance
  • Transurethral Resection of the Prostate (TURP) – Causes Endogenous Urokinase Release
  • Cardiopulmonary Bypass

Diagnosis

Diagnosis is Based on Clinical Picture and Correlative Lab Findings

Labs

  • Platelet Count: Normal – Different than DIC
  • PT and PTT: Normal or Prolonged
  • Fibrinogen: Low
  • Fibrin Split Products (D-Dimer): Elevated
  • Euglobulin Lysis Time (ELT): Shortened Lysis Time < 60-90 Minutes
    • The Traditional Screening Test but Difficult to Perform and Rarely Used Today
  • TEG: Increased LY30

Treatment

Treat Any Underlying Cause

Management

  • Primarily Supportive
  • May Consider Tranexamic Acid (TXA) or ε-Aminocaproic Acid