Systemic activation of fibrinolysis may develop in certain clinical situations, either as a primary or secondary process.

Risk factor


acute promyelocytic leukemia (APML)

release of plasminogen activators (distinct from risk for DIC)

disseminated malignancy

release of plasminogen activators

urologic surgery, especially prostatectomy

release of plasminogen activators

shock, severe trauma, major surgery or heatstroke

release of plasminogen activator

cardiopulmonary bypass

release of plasminogen activator

infusion of thrombolytic agents

release of plasminogen activator

disseminated intravascular coagulation (DIC)

release of plasminogen activator

hereditary deficiency in plasmin inhibitors (familial fibrinolysis)

decreased levels of plasmin inhibitors


decreased levels of plasmin inhibitors due to absorption onto amyloid fibrils

liver disease

decreased synthesis of plasmin inhibitors

liver disease, end-stage

decreased clearance of plasmin and plasminogen activators



• Plasmin inhibitors include alpha-2 antiplasmin and plasmin activator inhibitor-1.

• Thrombolytic agents include urokinase, streptokinase, and t-PA.

• Localized release of plasminogen activator can result in menorrhagia.


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