Physiologic and pharmacologic implications of fibrinolysis.

According to the thrombogenetic (encrustation) theory of atherogenesis first postulated by Rokitansky, accretions of blood components including fibrin and platelets may be the initial event. Since fibrinolysis has a profound influence on the resolution of fibrin deposits, the role of fibrinolysis in atherogenesis is discussed. Evidences supporting this role include the demonstration of inhibitors of fibrinolysis, decreased circulating fibrinolytic activity in patients who are atherosclerotic, and inhibition of circulating fibrinolytic activity by several atherosclerosis-risk factors such as increasing age, cigarette smoking, hypercholesterolemia, hypertriglyceridemia and diabetes mellitus. It is concluded that a combination of systemic inhibitions of fibrinolysis over a long-term period and a local vascular injury, play a decided role in atherogenesis.