Received: 11 August 2022

- -Revised: 16 January 2023

[Link]

ILLUSTRATED REVIEW
Accepted: 25 January 2023

Fibrinolysis: an illustrated review

Rebecca A. Risman BSc1 | Nicholas C. Kirby BSc2 | Brittany E. Bannish PhD3 |

Nathan E. Hudson PhD4 | Valerie Tutwiler PhD1

1
Rutgers University, New Brunswick, New
Jersey, USA Abstract
2
Department of Chemistry, East Carolina In response to vessel injury (or other pathological conditions), the hemostatic process is
University, Greenville, North Carolina, USA
activated, resulting in a fibrous, cellular-rich structure commonly referred to as a blood clot.
3
University of Central Oklahoma, Edmond,
Oklahoma, USA
Succeeding the clot’s function in wound healing, it must be resolved. This illustrated review
4
Department of Physics, East Carolina focuses on fibrinolysis—the degradation of blood clots or thrombi. Fibrin is the main me-
University Greenville, North Carolina, USA chanical and structural component of a blood clot, which encases the cellular components
Correspondence of the clot, including platelets and red blood cells. Fibrinolysis is the proteolytic degradation
Valerie Tutwiler, Department of Biomedical of the fibrin network that results in the release of the cellular components into the
Engineering, Rutgers - The State University
of New Jersey, 599 Taylor Road, Room 209, bloodstream. In the case of thrombosis, fibrinolysis is required for restoration of blood flow,
Piscataway, NJ 08854, USA. which is accomplished clinically through exogenously delivered lytic factors in a process
Email: [Link]@[Link]
called external lysis. Fibrinolysis is regulated by plasminogen activators (tissue-type and
Funding information urokinase-type) that convert plasminogen into plasmin to initiate fiber lysis and lytic in-
NIH R00HL148646-01 (V.T.), New Jersey
Commission for Cancer Research hibitors that impede this lysis (plasminogen activator inhibitors, alpha 2-antiplasmin, and
COCR22PRF010 (R.R.), NIH T32 thrombin activatable fibrinolysis inhibitor). Furthermore, the network structure has been
GM135141 (R.R.), NIH R15HL148842
(N.E.H.), and R15HL150666 (N.E.H.) shown to regulate lysis: thinner fibers and coarser clots lyse faster than thicker fibers and
finer clots. Clot contraction, a result of platelets pulling on fibers, results in densely packed
Handling Editor: M Sholzberg
red blood cells (polyhedrocytes), reduced permeability to fibrinolytic factors, and increased
fiber tension. Extensive research in the field has allowed for critical advancements leading
to improved thrombolytic agents. In this review, we summarize the state of the field,
highlight gaps in knowledge, and propose future research questions.

KEYWORDS
blood, blood coagulation, blood clot, clot lysis time, fibrinolysis, fibrin

Essentials
• Fibrinolysis is the degradation of the fibrin network of a blood clot.
• Fibrinolysis is required to achieve hemostatic balance.
• Fibrinolysis can occur naturally in the body or with delivery of pharmacological agents.
• Rate of fibrinolysis is affected by the fibrin structure and the clot’s cellular components.

-
Rebecca A. Risman and Nicholas C. Kirby contributed equally to this study.

© 2023 The Author(s). Published by Elsevier Inc. on behalf of International Society on Thrombosis and Haemostasis. This is an open access article under the CC BY-
NC-ND license ([Link]

Res Pract Thromb Haemost. 2023;7:e100081 [Link] 1 of 21

[Link]
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