Physiology

• Fibrin Degradation Products (FDP): plasmin cleaves polymerized fibrin at multiple sites and releases fibrin degradation products
  • D-Dimers: a type of fibrin degradation product which consists of two domains from adjacent fibrin monomers which have been cross-linked by activated factor XIII
    • D-dimers are generated from cross-linked fibrin (not fibrinogen), an elevated D-dimer concentration indicates the presence of recent or ongoing intravascular coagulation

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Elevated Plasma D-Dimer

Arterial Thrombembolic Disease

• Acute Limb Ischemia (see Acute Limb Ischemia, [[Acute Limb Ischemia]])
• Atrial Fibrillation (AF) (see Atrial Fibrillation, [[Atrial Fibrillation]])
• Intracardiac Thrombus (see Intracardiac Thrombus, [[Intracardiac Thrombus]])
• Ischemic Cerebrovascular Accident (CVA) (ee Ischemic Cerebrovascular Accident, [[Ischemic Cerebrovascular Accident]])
• Myocardial Infarction (MI) (see Myocardial Infarction, [[Myocardial Infarction]])

Venous Thromboembolic Disease

• Deep Venous Thrombosis (DVT) (see Deep Venous Thrombosis, [[Deep Venous Thrombosis]])
• Pulmonary Embolism (PE) (see Acute Pulmonary Embolism, [[Acute Pulmonary Embolism]])

Renal

• Acute Kidney Injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]])
• Chronic Kidney Disease (CKD) with Cardiovascular Disease (see Chronic Kidney Disease, [[Chronic Kidney Disease]])
• Nephrotic Syndrome (see Nephrotic Syndrome, [[Nephrotic Syndrome]])
• Renal Vein Thrombosis (see Renal Vein Thrombosis, [[Renal Vein Thrombosis]])

Obstetric

• Pre-Eclampsia/Eclampsia (see Pre-Eclampsia, Eclampsia, [[Pre-Eclampsia, Eclampsia]])
• Pregnancy (see Pregnancy, [[Pregnancy]])

Hyperfibrinolytic State (see Hyperfibrinolytic States, [[Hyperfibrinolytic States]])

Primary Hyperfibrinolytic States

• Alpha-2 Antiplasmin Deficiency (see Alpha-2 Antiplasmin Deficiency, [[Alpha-2 Antiplasmin Deficiency]])
• Plasminogen Activator Inhibitor-1 (PAI-1) Deficiency (see Plasminogen Activator Inhibitor-1 Deficiency, [[Plasminogen Activator Inhibitor-1 Deficiency]])

Secondary Hyperfibrinolytic States

• Cardiopulmonary Bypass (see Cardiopulmonary Bypass, [[Cardiopulmonary Bypass]])
  • Coagulopathy after cardiopulmonary bypass is multi-factorial and may include a component of hyperfibrinolysis
• Cirrhosis (see End-Stage Liver Disease, [[End-Stage Liver Disease]]): due to decreased tPA clearance from the circulation and decreased alpha-2 antiplasmin synthesis by the liver
• Disseminated Intravascular Coagulation (DIC) (see Disseminated Intravascular Coagulation, [[Disseminated Intravascular Coagulation]]): due to release of tPA, resulting in the generation of plasmin at site of injury
  • Acute Promyelocytic Leukemia (APML) (see Acute Promyelocytic Leukemia, [[Acute Promyelocytic Leukemia]])
  • Prostate Cancer (see Prostate Cancer, [[Prostate Cancer]])
    • DIC with secondary hyperfibrinolysis
    • Excessive production of urinary-type plasminogen activators by the malignant cells
    • Decreased alpha-2 antiplasmin synthesis
• Factor XI Deficiency (see Factor XI Deficiency, [[Factor XI Deficiency]]): due to decreased thrombin synthesis, resulting in decreased activation of thrombin activatable fibrinolysis inhibitor (TAFI)
• Heat Stroke (see Heat Stroke, [[Heat Stroke]])
• Hemophilia A (Factor VIII Deficiency) (see Hemophilia A, [[Hemophilia A]]): due to decreased thrombin synthesis, resulting in decreased activation of thrombin activatable fibrinolysis inhibitor (TAFI)
• Hemophilia B (Factor IX Deficiency) (see Hemophilia B, [[Hemophilia B]]): due to decreased thrombin synthesis, resulting in decreased activation of thrombin activatable fibrinolysis inhibitor (TAFI)
• Orthotopic Liver Transplantation (see Liver Transplant, [[Liver Transplant]]): due to decreased tPA clearance from the circulation and decreased alpha-2 antiplasmin synthesis (both of which occur during the anhepatic period of the transplant)
• Trauma
• Thrombolytics (see Thrombolytics, [[Thrombolytics]]): due to depletion of alpha-2 antiplasmin, plasminogen, and fibrinogen
  • Streptokinase (see Streptokinase, [[Streptokinase]])
  • Urokinase (see Urokinase, [[Urokinase]])

Other

• Congestive Heart Failure (CHF) (see Congestive Heart Failure, [[Congestive Heart Failure]])
• Malignancy
• Sickle Cell Disease Vaso-Occlusive Crisis (see Sickle Cell Disease, [[Sickle Cell Disease]])
• Surgery: with tissue ischemic/necrosis
• Systemic Inflammatory Response Syndrome (SIRS)/Sepsis (see Sepsis, [[Sepsis]])
• Venous Malformation

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References

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