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Fibrin Monomer in Thrombosis and Haemostasis: A Clinical Biomarker and Beyond
Konstantin Guria1, Ivan Melnikov1,2, Valentina Shtelmakh1
1National Medical Research Centre of Cardiology Named After Academician E.I. Chazov, Ministry of Health of the Russian Federation, 15A Akademika Chazova Street, 121552 Moscow, Russia.
Abstract:
Fibrin monomer (FM) is a transient intermediate of blood coagulation that functions as both an active regulator of haemostasis and a sensitive biomarker for prothrombotic states. Clinically, FM is measured indirectly as its derivative, soluble fibrin monomer complexes (SFMC), which is also often referred to as FM throughout the clinical literature. FM participates in a complex regulatory network modulating thrombin generation and fibrinolysis, interacting with platelet receptors, including integrin αIIbβ3 and GPVI, and engaging GPIb-vWF interactions. This comprehensive review examines FM's molecular mechanisms in haemostatic regulation and evaluates clinical evidence for FM as a biomarker. Particular focus is placed on FM's utility for risk stratification across thrombotic conditions, including disseminated intravascular coagulation, venous thromboembolism, ischemic stroke, myocardial infarction, and COVID-19-associated coagulopathy. Current challenges, including assay standardization and universal cut-off values, are discussed. By synthesizing mechanistic insights with clinical data, this integrated perspective may accelerate the translation of FM biology into improved risk assessment tools and novel therapeutic strategies.
Insights
Fibrin monomer (FM) is a key regulator of blood clotting and a biomarker for clotting risks. This review explores its mechanisms and clinical use for assessing conditions like stroke and heart attack.
Area of Science:
- Hematology
- Biochemistry
- Clinical Medicine
Background:
- Fibrin monomer (FM) is a crucial intermediate in blood coagulation.
- It acts as both a regulator of hemostasis and a biomarker for prothrombotic states.
- Clinically, FM is often measured indirectly as soluble fibrin monomer complexes (SFMC).
Purpose of the Study:
- To review the molecular mechanisms of FM in hemostatic regulation.
- To evaluate clinical evidence supporting FM as a biomarker for thrombotic conditions.
- To discuss challenges and future directions for FM's clinical application.
Main Methods:
- Comprehensive literature review of FM's role in hemostasis.
- Analysis of molecular interactions involving FM, platelets, and coagulation factors.
- Evaluation of clinical studies on FM as a biomarker for various thrombotic diseases.
Main Results:
- FM plays a complex role in modulating thrombin generation and fibrinolysis.
- FM interacts with platelet receptors (integrin αIIbβ3, GPVI) and GPIb-vWF interactions.
- Clinical data supports FM's utility in risk stratification for conditions including VTE, stroke, MI, and COVID-19 coagulopathy.
Conclusions:
- FM's intricate molecular functions are vital for hemostasis.
- FM shows significant promise as a biomarker for assessing thrombotic risk.
- Standardization of assays and universal cut-off values are needed for broader clinical adoption.
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