Hemodynamics, fluids & transfusion
Point-of-care diagnosis and monitoring of fibrinolysis resistance in the critically ill: results from a feasibility study
Authors' conclusion
ClotPro viscoelastic testing, the associated TPA-test and the novel experimental assays may be utilised to (i) investigate the potential mechanisms of fibrinolysis resistance, (ii) guide corrective treatment and (iii) monitor in real-time the treatment effect.
Study context
- Population
- Critically ill patients with fibrinolysis resistance (clot lysis time > 300 s on the ClotPro TPA-test)58 fibrinolysis-resistant, 32 tested ex vivo
- Participants
- 105 patients
- Exposure
- Ex vivo supplementation of TPA-test with tissue plasminogen activator (t-PA) and/or plasminogen; 24 h IV low-dose alteplase infusion in one patient
- Outcome
- Ability of t-PA and plasminogen supplementation to restore fibrinolysis, assessed by point-of-care ClotPro viscoelastic testing (VET)
Methodological detailsprospective, observational, ex vivo experimental viscoelastic testing, single-patient interventional study
- Prospective
- Observational
- Ex vivo experimental viscoelastic testing
- Single-patient interventional study
Main finding
As reported in the abstract
Ex vivo response to supplementation (TPA-test lysis time)
- Distinct response groups: increased fibrinolysis after supplementation with (i) t-PA only or (ii) plasminogen and t-PA
- Baseline TPA-test lysis time > 1000 s associated with the plasminogen and t-PA response group
Observational data: associations, not effects.
Further findings
Serial TPA-test lysis times during 24 h IV low-dose alteplase infusion (one patient with acute respiratory failure (ARF))
- Gradual reduction in TPA-test lysis times
- 25%
Original publication
Point-of-care diagnosis and monitoring of fibrinolysis resistance in the critically ill: results from a feasibility study. Crit Care. Published 10 February 2023. doi:10.
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