Regulation by tranexamic acid and thrombomodulin of hyperfibrinolysis induced by tissue plasminogen activator in human whole blood

Abstract

We used thromboelastometry (ROTEM) to study the opposing fibrinolytic properties of thrombomodulin (TM) and tranexamic acid (TA) during tissue plasminogen activator
(tPA)-induced hyperfibrinolysis. tPA addition to whole human blood induced hyperfibrinolysis in all samples. In these EXTEM (extrinsic haemostasis) tests, there were significant decreases after tPA addition in lysis indices at 45 and 60 min (LI45 and LI60, respectively). Maximum lysis (ML) and clotting time (CT) significantly increased with tPA addition as compared with the saline control. TA significantly decreased tPA-induced hyperfibrinolysis. With TM addition, LI60 and ML did not significantly change, though LI45, lysis time and lysis onset time were significantly increased as compared with tPA alone. In conclusion, in ROTEM assays using whole blood, TA significantly attenuated tPA-induced hyperfibrinolysis, while TM failed to do so.