title: The fibrinolytic system-more than fibrinolysis?
abstract: The fibrinolytic system, known for its ability to regulate the activation of the zymogen plasminogen into active plasmin, has been primarily associated with the removal of fibrin and blood clots. Tissue-type plasminogen activator, the most well-recognized plasminogen activator, was harnessed for therapeutic benefit against thromboembolic disorders more than 30 years ago, whereas inhibition of this system has been proven effective for certain bleeding disorders. However, in recent years, new and unexpected functional roles for this system have been identified mostly in relation to the central nervous system that are both unrelated and independent of fibrin degradation and clot removal. Hence, it seems reasonable to ask whether agents used to modify components or activities of the fibrinolytic system have any clinical consequences unrelated to their intended use in hemostasis. This review will provide an overview of these new features of the fibrinolytic system and will also focus on prospective considerations in the use of fibrinolytic and antifibrinolytic agents.
authors.affiliation: Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia.
authors.forename: Dominik F
authors.initials: DF
authors.lastname: Draxler
authors.affiliation: Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia. Electronic address: robert.medcalf@monash.edu.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Medcalf
mesh_terms: D000818:Animals; D002490:Central Nervous System / Q000502:physiology; D005341:Fibrinolysin / Q000502:physiology; D005342:Fibrinolysis / Q000502:physiology*; D006470:Hemorrhage / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D051379:Mice; D009419:Nerve Tissue Proteins / Q000502:physiology; D009473:Neuronal Plasticity / Q000502:physiology; D018696:Neuroprotective Agents / Q000494:pharmacology; D009498:Neurotoxins / Q000494:pharmacology; D016032:Randomized Controlled Trials as Topic; D016194:Receptors, N-Methyl-D-Aspartate / Q000502:physiology; D010959:Tissue Plasminogen Activator / Q000494:pharmacology / Q000502:physiology / Q000633:toxicity; D014148:Tranexamic Acid / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D014945:Wound Healing / Q000187:drug effects / Q000502:physiology
chemical_list: D018836:Inflammation Mediators; D009419:Nerve Tissue Proteins; D018696:Neuroprotective Agents; D009498:Neurotoxins; D016194:Receptors, N-Methyl-D-Aspartate; D014148:Tranexamic Acid; D010959:Tissue Plasminogen Activator; D005341:Fibrinolysin
keywords: Fibrinolysis; Plasmin; Plasminogen activation; Tranexamic acid; t-PA