Rapid plasma-based screening of fibrinolytic activation in trauma: a single-center observational cohort study
4 affiliations
- 1Blood Research Center and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- 2Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- 3Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
- 4Department of Surgery, University of Colorado-Denver/Anschutz Medical Campus, Denver, Colorado, USA
Abstract
Background: Viscoelastic testing is commonly used to assess fibrinolytic phenotypes in trauma, with values of thromboelastogram (TEG) clot lysis at 30 minutes after maximum amplitude (LY30) >3% considered indicative of hyperfibrinolysis. The "Fibrinolytic Activation Screening Test" (FAST) is a rapid assay that detects endogenous tissue plasminogen activator–dependent and plasmin-dependent fibrinolytic activation.
Objectives: This study aimed to evaluate FAST activity in trauma and determine its correlation with other indices of fibrinolytic activation, including plasmin-antiplasmin (PAP) complexes and TEG LY30.
Methods: FAST activity and PAP complexes were assayed in archived plasma samples from 99 patients with trauma on presentation. We evaluated the association of FAST activity with 4 different PAP thresholds (>2000 ng/mL, >5000 ng/mL, >10,000 ng/mL, or >20,000 ng/mL) representing increasing degrees of fibrinolytic activation.
Results: FAST activity was elevated in 65% of patients with trauma on admission. By Spearman’s rank correlation, FAST activity was strongly correlated with PAP complexes (rs = 0.74). The strong association of FAST activity with all 4 PAP thresholds was more pronounced with increasing cutoffs, indicating enhanced specificity of FAST activity with greater fibrinolytic activation. TEG LY30 showed no correlation with FAST activity (rs = –0.07) and no correlation with PAP complexes (rs = –0.18). In an exploratory analysis, the FAST assay demonstrated good discriminatory performance for in-hospital mortality by receiver operating characteristic analysis (area under the curve, 0.8023; 95% CI, 0.6417-0.9630).
Conclusion: The FAST assay is a rapid and specific measure of fibrinolytic activation in trauma.
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BibTeX
@article{ilich2026rapid,
title = {{Rapid plasma-based screening of fibrinolytic activation in trauma: a single-center observational cohort study}},
author = {Anton Ilich and Izabela Pawlinski and Matthew J. Eckert and Linda E. Sousse and Jared R. Gallaher and Myung S. Park and Alyssa Caldwell-McGee and Mitchell J. Cohen and Jessica C. Cardenas and Nigel S. Key},
journal = {Research and Practice in Thrombosis and Haemostasis},
year = {2026},
month = oct,
doi = {10.1016/j.rpth.2026.106999},
url = {https://doi.org/10.1016/j.rpth.2026.106999},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Rapid plasma-based screening of fibrinolytic activation in trauma: a single-center observational cohort study
AU - Anton Ilich
AU - Izabela Pawlinski
AU - Matthew J. Eckert
AU - Linda E. Sousse
AU - Jared R. Gallaher
AU - Myung S. Park
AU - Alyssa Caldwell-McGee
AU - Mitchell J. Cohen
AU - Jessica C. Cardenas
AU - Nigel S. Key
PY - 2026
DA - 2026/10/01
JO - Research and Practice in Thrombosis and Haemostasis
DO - 10.1016/j.rpth.2026.106999
UR - https://doi.org/10.1016/j.rpth.2026.106999
AB - Background: Viscoelastic testing is commonly used to assess fibrinolytic phenotypes in trauma, with values of thromboelastogram (TEG) clot lysis at 30 minutes after maximum amplitude (LY30) >3% considered indicative of hyperfibrinolysis. The "Fibrinolytic Activation Screening Test" (FAST) is a rapid assay that detects endogenous tissue plasminogen activator–dependent and plasmin-dependent fibrinolytic activation. Objectives: This study aimed to evaluate FAST activity in trauma and determine its correlation with other indices of fibrinolytic activation, including plasmin-antiplasmin (PAP) complexes and TEG LY30. Methods: FAST activity and PAP complexes were assayed in archived plasma samples from 99 patients with trauma on presentation. We evaluated the association of FAST activity with 4 different PAP thresholds (>2000 ng/mL, >5000 ng/mL, >10,000 ng/mL, or >20,000 ng/mL) representing increasing degrees of fibrinolytic activation. Results: FAST activity was elevated in 65% of patients with trauma on admission. By Spearman’s rank correlation, FAST activity was strongly correlated with PAP complexes (rs = 0.74). The strong association of FAST activity with all 4 PAP thresholds was more pronounced with increasing cutoffs, indicating enhanced specificity of FAST activity with greater fibrinolytic activation. TEG LY30 showed no correlation with FAST activity (rs = –0.07) and no correlation with PAP complexes (rs = –0.18). In an exploratory analysis, the FAST assay demonstrated good discriminatory performance for in-hospital mortality by receiver operating characteristic analysis (area under the curve, 0.8023; 95% CI, 0.6417-0.9630). Conclusion: The FAST assay is a rapid and specific measure of fibrinolytic activation in trauma.
SN - 2475-0379
ER -