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The fibrinolytic system in newborns and children
Nagina Parmar1, Manuela Albisetti, Leslie R Berry
1Pediatric Thrombosis and Hemostasis Program, The Hospital for Sick Children, Toronto, Canada.
Insights
The pediatric fibrinolytic system differs significantly from adults, impacting disease development and fibrinolytic therapy effectiveness in children and newborns. Understanding these age-dependent changes is crucial for effective treatment.
Area of Science:
- Biochemistry
- Pediatric Physiology
- Hemostasis
Background:
- The fibrinolytic system, crucial for breaking down blood clots, involves serine proteases.
- Key components are present at birth, but concentrations and activity change with age.
Purpose of the Study:
- To review age-dependent features of the pediatric fibrinolytic system.
- To examine its role in childhood diseases and impact on fibrinolytic therapy.
Main Methods:
- Literature review of studies on pediatric fibrinolysis.
- Analysis of age-related changes in fibrinolytic components and activity.
- Evaluation of clinical implications in healthy and diseased children.
Main Results:
- Children exhibit lower levels of plasminogen, tissue-type plasminogen activator, and alpha2-antiplasmin.
- Higher levels of plasminogen activator inhibitor-1 are observed in children.
- Reduced plasmin generation and overall fibrinolytic activity are noted in pediatric populations.
Conclusions:
- Age-dependent alterations in the fibrinolytic system are significant in children.
- These differences may predispose children to certain diseases and affect fibrinolytic treatment outcomes.
- Further research is needed to optimize therapeutic strategies for pediatric patients.
Abstract:
The fibrinolytic system comprises a series of serine proteases that interact to cleave fibrin into fibrin degradation products. Although all key components of the fibrinolytic system are present at birth, important age-dependent, quantitative and qualitative differences are present during childhood as compared to adults. These differences include decreased plasma concentrations of plasminogen, tissue-type plasminogen activator and alpha2-antiplasmin, increased plasma concentrations of plasminogen activator inhibitor-1, as well as a decrease in both plasmin generation and overall fibrinolytic activity. Increasing evidence suggests that these age-dependent differences may contribute to the development of specific childhood diseases and influence the course of fibrinolytic therapy, particularly in newborns. This review aims to summarize the available information on the age-dependent features of the fibrinolytic system in newborns and children in healthy and disease states and the impact of these features on fibrinolytic therapy.
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