Related Experiment Video

Updated: Aug 6, 2026

The Nijmegen Hemostasis Assay: Simultaneous Fluorogenic Measurement of Thrombin and Plasmin Generation in a Single Well
08:01

The Nijmegen Hemostasis Assay: Simultaneous Fluorogenic Measurement of Thrombin and Plasmin Generation in a Single Well

Published on: February 27, 2026

Venous thromboembolism is not associated with plasmin(ogen): reevaluating plasmin and mechanisms that degrade fibrin

Yaqiu Sang1, Amy D Shapiro2, Alisa S Wolberg1

  • 1Department of Pathology and Laboratory Medicine and UNC Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC.

Blood Advances
|July 20, 2026
PubMed

The plasminogen activation and plasmin activity (PA) system is a central mechanism for degrading fibrin and has long been viewed as essential for preventing venous thrombosis/thromboembolism. However, clinical and experimental data challenge this paradigm. Here, we examine evidence that reduced PA does not predispose individuals to venous thrombosis/thromboembolism. We discuss potential mechanisms that may rationalize this apparent paradox, including compensatory vascular and inflammatory pathways that may degrade intravascular fibrin. These data suggest venous thromboembolism is a multifactorial disease in which an impaired PA system is neither necessary nor sufficient to drive thrombosis. We also discuss alternative biological roles of the PA system. Reframing the role of the PA system has important implications for developing therapies that modulate fibrinolysis. A more nuanced understanding of PA biology may enable strategies that balance bleeding risk with efficient clot resolution.

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