Increased fibrinolysis can occur during orthotopic liver transplant surgery.

Possible mechanism: both increased release of tissue plasminogen activator from endothelial cells and reduced hepatic clearance


A marked increase in fibrinolysis may occur after graft reperfusion and was associated with a decrease in plasminogen activator inhibitor activity.


Clinical features: severe oozing


Laboratory findings:

(1) fall in plasma fibrinogen

(2) increase in fibrin split products


Measures of fibrinolysis:

(1) euglobulin clot lysis time

(2) whole blood clot lysis time by thromboelastography


Severe fibrinolysis defined as both of the following:

(1) euglobulin clot lysis time < 60 minutes

(2) whole blood clot lysis time < 90 minutes

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