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      Endogenous Fibrinolysis: An Important Mediator of Thrombus Formation and Cardiovascular Risk.

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          Abstract

          Most acute cardiovascular events are attributable to arterial thrombosis. Plaque rupture or erosion stimulates platelet activation, aggregation, and thrombosis, whilst simultaneously activating enzymatic processes that mediate endogenous fibrinolysis to physiologically maintain vessel patency. Interplay between these pathways determines clinical outcome. If proaggregatory factors predominate, the thrombus may propagate, leading to vessel occlusion. However, if balanced by a healthy fibrinolytic system, thrombosis may not occur or cause lasting occlusion. Despite abundant evidence for the fibrinolytic system regulating thrombosis, it has been overlooked compared with platelet reactivity, partly due to a lack of techniques to measure it. We evaluate evidence for endogenous fibrinolysis in arterial thrombosis and review techniques to assess it, including biomarkers and global assays, such as thromboelastography and the Global Thrombosis Test. Global assays, simultaneously assessing proaggregatory and fibrinolytic pathways, could play a role in risk stratification and in identifying impaired fibrinolysis as a potential target for pharmacological modulation.

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          Author and article information

          Journal
          J. Am. Coll. Cardiol.
          Journal of the American College of Cardiology
          1558-3597
          0735-1097
          Apr 28 2015
          : 65
          : 16
          Affiliations
          [1 ] East & North Hertfordshire NHS Trust, Hertfordshire, United Kingdom.
          [2 ] East & North Hertfordshire NHS Trust, Hertfordshire, United Kingdom; Vascular Sciences, National Heart & Lung Institute, Imperial College, London, United Kingdom. Electronic address: d.gorog@imperial.ac.uk.
          Article
          S0735-1097(15)00730-5
          10.1016/j.jacc.2015.02.040
          25908074
          9caa4dac-c80c-4ce9-b50b-c1ebbfb678b8
          Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
          History

          atherosclerosis,platelet activation,platelet aggregation,platelet function tests,thrombolysis,thrombosis

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