Deranged Balance of Hemostasis and Fibrinolysis in Disseminated Intravascular Coagulation: Assessment and Relevance in Different Clinical Settings

Maintaining appropriate hemostasis requires a balanced relationship between coagulation and fibrinolysis and is essential for overall homeostasis. The activation of coagulation is a fundamental response to injury and infection, necessary to stop bleeding and pathogen spread as a component of host defense and triggered by activation of the innate immune system. Fibrinolysis is a coordinated process responsible for fibrin removal and clot dissolution, which is critically important for maintaining vascular patency and organ perfusion. In addition, the fibrinolytic system has been found to play a role in the immune response and wound healing processes.

A disturbed balance between clot formation and dissolution may ultimately progress to microthrombosis and organ failure when the balance favors either coagulation or insufficient clot dissolution or to bleeding when the balance shifts toward fibrinolysis. When the equilibrium between hemostasis and fibrinolysis is lost, the clinically relevant consequences include coagulopathies with different degrees of severity, potentially...