Sept, 2020 Quick Question Reponse: Fibrinolysis

Here are our responses to the September, 2020 Quick Question, wich attracted 51 participants.

How does your facility measure fibrinolysis?

1. Plasminogen: 3 [5%]
2. Tissue plasminogen activator [TPA]: 1 [2%]
3. Plasminogen activator inhibitor 1 [PAI-1]: 1 [2%]
4. Thromboelastograph [TEG]: 10 [20%]
5. Rotational thromboelastometry [ROTEM]: 36 [71%]

As we speculated the first three measures of fibrinolysis are rarely performed, and are mostly accesible from specialty reference laboratories, perhaps because they require special specimen management to prevent post-collection in vivo fibrinolysis, especially TPA. The TEG and ROTEM offer global near-patient assays that report fibrinolysis as the LY-30 [TEG] or the ML. Both measures are seen to report hypofibrinolysis in SARS-CoV-2 infection. Panigada M, Bottino N, Tagliabue P, et al. Hypercoagulability of COVID-19 patients in intensive care unit. A report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost doi: 10.1111/JTH.14850

The percentage of ROTEM versus TEG selections may reflect the demographics of our participants, as the ROTEM is prevalent in Europe while the TEG is popuar in North America.