ArticleThe journal of trauma and acute care surgery2025
The tissue-plasminogen activator-challenged thromboelastography provides a comprehensive assessment of fibrinolysis in the severely injured.
Article in The journal of trauma and acute care surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Real-Time Fibrinolysis Monitoring of Plasma Annular Clots.Biomolecules · 2026Article
- Is "Physiological Lysis" in Viscoelastometry a Plasmin-Mediated Process?Diagnostics (Basel, Switzerland) · 2026Article
- Optimizing hemorrhage management in trauma: integrative roles of tranexamic acid and tissue plasminogen activator-augmented viscoelastic testing.Journal of thrombosis and thrombolysis · 2026Review
- Change in novel plasmin activated clotting time assay predicts hyperfibrinolysis, massive transfusion, and mortality in trauma in under 3 minutes.American journal of surgery · 2025Article
- Hyperfibrinolysis in Cats: A Retrospective Case-Control Study of 154 Cats.Journal of veterinary internal medicineArticle
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Abstract
backgroundTissue-plasminogen activator-challenged thromboelastography (tPA-TEG) predicts massive transfusion and mortality better than conventional rapid thromboelastography (rTEG), with little concordance between their lysis values (LY30). We hypothesized that the main fibrinolytic inhibitors plasminogen activator inhibitor-1 (PAI-1) and α-2 antiplasmin (A2AP), as well as markers of fibrinolytic activation (plasmin-antiplasmin [PAP], tPA-PAI-1 complex, tPA activity), would correlate more strongly with tPA-TEG versus rTEG LY30 and may explain the recent findings of four distinct fibrinolytic phenotypes in trauma based on these two TEG methodologies.
methodsAdult trauma patients (n = 56) had tPA-TEG, rTEG, and plasma obtained on arrival to the emergency department with institutional review board approval. Plasminogen activator inhibitor-1 activity, A2AP, PAP, and tPA-PAI-1 complex as well as tPA activity were measured. Data were analyzed using Spearman's correlations and analysis of variance.
resultsThe median age was 34 years, 75% were male, and the New Injury Severity Score was 14. Mortality was 25%, and 23% required a massive transfusion. There was a significant negative correlation between PAI-1 activity and A2AP with tPA-TEG LY30 ( r = -0.77, p < 0.0001 and r = -0.62, p < 0.0001). There was a significant positive correlation between PAP complex and tPA-TEG LY30 ( r = 0.74, p < 0.0001). There was no correlation between any fibrinolytic analyte and rTEG LY30. When stratified by phenotype, patients with hypofibrinolysis and nonpathologic fibrinolysis had higher active PAI-1 ( p < 0.05) and A2AP levels ( p < 0.05), lower PAP ( p < 0.05), and tPA-PAI-1 complex ( p < 0.05). Tissue-plasminogen activator activity was higher in hyperfibrinolysis relative to the other three groups ( p < 0.05).
conclusionTissue-plasminogen activator-TEG LY30 more accurately reflects fibrinolysis phenotypes in trauma patients than conventional TEG methods. This provides an explanation for tPA-TEG's superior performance over rTEG in predicting clinical outcomes. LEVEL OF EVIDENCE: Diagnostic Tests/Criteria; Level III.
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