Fibrinolytic bleeding

During the last few years, increasing attention has been paid to reports demonstrating the influence of the fibrinolytic system on increased peri -and postoperative bleeding in terms of anti-fibrinolytic prophylaxis and treatment of bleeding. Particularly, attention is focused on trauma coagulopathy and fibrinolytic system activation through to Protein C activation in early haemorrhage shock stages. It is well established that hyper-fibrinolysis occurs in 30–50% of patients undergoing major surgery (cardiac, vascular, liver, orthopaedics, obstetrics) and in 80% of trauma patients. However, inter-individual variations are relatively large due to different inhibitory potential of fibrinolysis determinate by mechanism of injury and genetic predisposition to higher fibrinolytic activity. Moreover, it is often difficult to sort out whether bleeding results only from surgical or trauma injury alone, or from concomitantly occurring coagulopathy with hyper-fibrinolysis detected by viscoelastic tests. Therefore, it is essential to refresh the knowledge of fibrinolysis, both with regard to its pathophysiology, ways of activation, diagnostic tools including viscoelastic testing and individual genetic markers that can lead to a goal-directed treatment. Fibrinolytic system activation occurs in most of major surgery and bleeding cases. Early prophylaxis, recognition and treatment is essential to reduce haemotransfusion rates and to improve surviving in major bleeding patient.