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Fibrinolytic markers and cardiovascular risk

Robert S Rosenson, MD
Section Editor
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Deputy Editor
Gordon M Saperia, MD, FACC


Elevated plasma concentrations of fibrinogen appear to be an independent predictor of initial and recurrent cardiovascular events. There is also increasing evidence that markers of impaired fibrinolysis are associated with both the development of coronary heart disease (CHD) and, in patients with CHD, an increased number of coronary events [1].

Atherosclerotic plaque rupture and erosions are recognized precipitants of thrombosis and lead to an acute ischemic syndrome [2-4]. (See "The role of the vulnerable plaque in acute coronary syndromes".)

The thrombotic response to vascular injury is influenced by a variety of factors, including the thrombogenicity of the vessel wall [5], platelet deposition, local blood flow (which is influenced by rheologic properties) [6,7], and the effectiveness of protective fibrinolytic mechanisms [8-10]. (See "The role of platelets in coronary heart disease" and "Vascular endothelial function and fundamental mechanisms of fibrinolysis (thrombolysis)".)


Fibrinolytic activity is regulated by a balance between plasminogen activators, such as tissue-type plasminogen activator (t-PA), and inhibitors, such as plasminogen activator inhibitor type 1 (PAI-1), alpha-2-antiplasmin, and lipoprotein (a). PAI-1 is a major determinant of the resistance of platelet-rich arterial thrombi to thrombolysis as it binds to and inactivates both t-PA and urokinase-type plasminogen activator [11,12]. (See "Thrombotic and hemorrhagic disorders due to abnormal fibrinolysis".)

Decreased fibrinolytic activity is characterized by prolonged clot lysis times and elevated plasma concentrations of PAI-1 and t-PA antigen. Circulating t-PA antigen consists mainly of t-PA/PAI-1 complexes and lesser amounts of free t-PA. (See "Approach to the adult patient with a bleeding diathesis", section on 'Tests for fibrinolysis'.)


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Literature review current through: Sep 2016. | This topic last updated: Apr 29, 2015.
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