Fibrinolysis

Abstract

Derangement of fibrinolysis has been in the interest of surgical scientist for over 200 years. Appreciation of the spectrum of fibrinolysis following severe injury confirms the long perceived notion that pathology occurs at the extremes of any protease system. Trauma can cause overactivation of fibrinolysis resulting in uncontrolled bleeding or inhibition resulting in fibrinolysis shutdown resulting in organ dysfunction. While the CRASH II trial demonstrated a modest benefit in survival using an antifibrinolytic medication in trauma patients, there are likely superior resuscitation strategies to improve survival in patients with abnormal fibrinolytic function. This chapter is intended to refresh the reader’s historic appreciation of surgery trauma and fibrinolysis and stress the physiologic role of the fibrinolytic system in response to injury.