Preface: Altered Fibrinolysis—Clinical Impact and Diagnostic Challenges

Fibrinolysis is the physiological and continuous process of plasmin-mediated fibrin breakdown, which is regulated to keep the balance between ensuring continued blood supply to end organs and maintaining hemostasis in the face of vascular damage.[ 1 ] The importance of a well-regulated fibrinolytic system is illustrated by rare inherited and acquired disorders of fibrinolysis with severe bleeding phenotypes.[ 2 ] Moreover, a growing body of evidence demonstrates that altered fibrinolysis plays a pivotal role in the pathophysiology of a range of clinical conditions, and markers of fibrinolysis hold the potential to predict adverse events such as bleeding and thrombosis.[ 3 ] Finally, drugs which modulate fibrinolysis have life-saving potential and are used to treat millions of patients each year worldwide, both in the form of profibrinolytics used for thrombolysis, for example, in ischemic stroke and pulmonary emboli, and as antifibrinolytics used to mitigate traumatic, surgical, and postpartum bleeding. In the current issue of Seminars in Thrombosis and Hemostasis , we have assembled review articles dealing with the fibrinolytic system in pathophysiology, diagnosis, and treatment of clinical disorders, including arterial and venous thrombosis, cancer, sepsis, and liver disease to traumatic brain injury. Furthermore, the use of tranexamic acid in trauma and pediatric surgery is reviewed, and the implication of an emerging treatment, ischemic preconditioning, for fibrinolysis in ischemic stroke is discussed. Publication History Article published online: 30 June 2021 © 2021. Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA