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Article Abstract
Introduction: Congenital or acquired dysregulation of fibrinolytic system can lead to bleeding (hyperfibrinolysis) or thrombosis (hypofibrinolysis), with increased risk for multi-organ failure. Standard clotting-based assays provide limited insight into fibrinolytic status. In contrast, thromboelastography (TEG), a whole blood assay, offers a comprehensive assessment of the coagulation and fibrinolytic systems. While freezing plasma samples enables later investigation of plasmatic coagulation factors, viscoelastic testing (VT) requires immediate testing. In this study, we evaluated a new diagnostic approach to assess fibrinolysis in frozen plasma samples spiked into healthy whole blood using VT.
Methods: Citrated whole blood and corresponding frozen platelet-poor plasma (PPP) samples from patients with hypofibrinolytic disorders were analyzed using thromboelastography (TEG). The spike-in method involved reconstituting patient-derived frozen PPP into plasma-depleted blood from healthy subjects. In addition, the Lysis Timer®, a global fibrinolysis capacity assay, was used to assess fibrinolysis in plasma samples.
Results: The validation study showed strong correlation between lysis time (LT) of VT in healthy whole blood and spiked samples (r = 0.6720, p = 0.0012). Hypofibrinolytic patients exhibited significantly increased LT in the tissue plasminogen activator-test of VT (LT-TPA) when their PPP was spiked into healthy whole blood, confirming hypofibrinolytic activity (LT-TPA whole blood of healthy donors vs. spike-in with patients, PPP: 165.7 ± 16.6 s vs. 218.3 ± 39.6 s, p < 0.0001). The Lysis Timer assay supported these findings, suggesting a plasmatic factor rather than cell-derived resistance to fibrinolysis.
Conclusion: The spike-in approach can be used to retrospectively detect hypofibrinolysis in frozen samples using TEG. This method is particularly useful for clinical studies when immediate VT is not available.
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| http://dx.doi.org/10.1016/j.thromres.2025.109430 | DOI Listing |
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