Impaired spontaneous/endogenous fibrinolytic status as new cardiovascular risk factor? JACC Review Topic of the Week

Endogenous fibrinolysis is a powerful natural defence mechanism against lasting arterial thrombotic occlusion. Recent prospective studies show that impaired endogenous fibrinolysis (or hypofibrinolysis) can be detected in a significant number of patients with acute coronary syndrome (ACS) using global assays and is a strong marker of future cardiovascular risk. This novel risk biomarker is independent of traditional cardiovascular risk factors and unaffected by antiplatelet therapy. Nevertheless, the optimal test to assess endogenous fibrinolysis is not clear. Most prospective, prognostic data have been obtained using a global assay employing native whole blood at high shear or plasma turbidimetric assays. For example, tests of endogenous fibrinolysis could be used to identify ACS patients who, despite antiplatelet therapy, remain at high cardiovascular risk. Clinical trials of pharmacotherapy to favourably modulate fibrinolytic status are required as a potential new avenue to improve outcomes in ACS.