Evidence map›Paper›PMID 40745248›Full record

ReviewAnnals of intensive care2025

Utility of fibrinolysis enhanced viscoelastic assays to evaluate fibrinolysis disorders in critically ill adults with severe infection: a scoping review.

Matthew Self, Lucy A Coupland, Anders Aneman

Abstract readReview
In one paragraph

Review in Annals of intensive care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Reference Intervals for ROTEM-tPA: Whole-Blood Fibrinolysis Assessment in Healthy Adults.TH open : companion journal to thrombosis and haemostasis · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Matthew SelfIntensive Care Unit, Liverpool Hospital, Liverpool, Australia.
Lucy A CouplandIntensive Care Unit, Liverpool Hospital, Liverpool, Australia. l.coupland@unsw.edu.au.ORCID http://orcid.org/0000-0002-8912-9534
Anders AnemanIntensive Care Unit, Liverpool Hospital, Liverpool, Australia. anders.aneman@health.nsw.gov.au.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAcutely infected critically ill patients develop coagulopathies and perturbations to the fibrinolysis system that manifest as immunothrombosis. Whole blood viscoelastic testing, using an exogenous fibrinolytic agent to enhance fibrinolysis (FE-VET) can assess both processes of coagulation and fibrinolysis at the bedside. This scoping review aimed to illustrate clinical applicability, knowledge gaps and unmet needs for this emerging technology.

methodsA systematic search of bibliographic databases and the grey literature was performed between the 10th October 2024 and the 14th January 2025 using a pre-published protocol and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline for scoping reviews (PRISMA-ScR). Studies reporting FE-VET to investigate fibrinolysis in acutely infected patients admitted to the intensive care unit were assessed, including associations with disease severity and clinical outcomes.

resultsThe search identified 297 studies with 24 included in this review. Fifteen studies were observational (12 prospective, 3 retrospective), 4 case reports and series, 2 validation studies, 2 letters, and 1 poster abstract. No randomised controlled trials were identified. Most studies used varying concentrations of tissue plasminogen activator (tPA) to enhance fibrinolysis, with FE-VET performed at a single time point and the lysis time to achieve 50% reduction of maximum clot firmness being the most frequently reported variable. Fibrinolysis resistance was the prevailing state reported in acute sepsis or COVID-19 infections and associated with increased disease severity and worse clinical outcomes.

conclusionViscoelastic testing using a fibrinolysis enhancing agent demonstrated a spectrum of fibrinolysis resistance in acutely infected critically ill patients, associated with increased disease severity and mortality. Standardisation of the concentrations of fibrinolysis enhancing agents and the reporting of clot lysis parameters across testing devices are needed to establish reference values. This would improve future clinical studies of fibrinolysis, including trials of fibrinolytic therapies using a personalised medicine approach.

Indexed as

Blood coagulation disordersCritical illnessFibrinolysisPoint-of-care technologySepsisThromboelastography

Identifiers

PMID40745248
PMCPMC12314158

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.