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Plasmin-α2-antiplasmin complex

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Plasmin-α2-antiplasmin complex (PAP) is a 1:1 irreversibly formed inactive complex of the enzyme plasmin and its inhibitor α2-antiplasmin.[1][2][3][4] It is a marker of the activity of the fibrinolytic system and a marker of net activation of fibrinolysis.[5][6] Excess of the PAP complex can lead to abnormal bleeding due to enhanced clot lysis leading to a hyperfibrinolytic state.[7] The PAP complex can be useful in the determining the prognosis of a clot, but it is limited because it is measured using ELISA. [7]

Various uses of PAP as a marker

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Low PAP levels can be indicative that patients with a past myocardial infarction have a higher risk of another coronary event within the following 2 years.[8] Specifically, when PAP levels are less than 100 ng/ml there was an associated 2.2-fold increase in the risk for another coronary event.[8] When the cut off is less than 100 there is a 5-fold increase in risk.[8] This marker is useful in the clinical setting as a potential way to identify patients that are at higher risk. However, there was not a significant difference between the PAP levels of patients that were on anticoagulative therapy versus patients that were not on anticoagulative therapy.[8] PAP is an independent marker for the risk of another coronary event post-MI, as the risk analysis remained constant when confounding factors (e.g. age, sex, BMI, smoking history, etc.) were controlled for.[8]

PAP levels are increased with pregnancy[9] and by ethinylestradiol-containing combined birth control pills.[5] Conversely, levels of PAP do not appear to be affected with menopausal hormone therapy.[6] PAP levels have been reported to be elevated in men with prostate cancer.[10] PAP can be useful in predicting if a patient is at high risk for a perioperative pulmonary embolism.[7]

References

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  1. ^ Gebbink MF (July 2011). "Tissue-type plasminogen activator-mediated plasminogen activation and contact activation, implications in and beyond haemostasis". J Thromb Haemost. 9 Suppl 1: 174–81. doi:10.1111/j.1538-7836.2011.04278.x. PMID 21781253. S2CID 26701294.
  2. ^ R.F.A. Zwaal; H.C. Hemker, eds. (1 January 1986). Blood Coagulation. Elsevier. pp. 250–. ISBN 978-0-08-086072-5. OCLC 1058474585.
  3. ^ Jun Teruya, ed. (5 January 2021). Management of Bleeding Patients (2 ed.). Springer Nature. pp. 41–. ISBN 978-3-03-056338-7. OCLC 1058318800.
  4. ^ Kandice Kottke-Marchant; Bruce Davis, eds. (7 May 2012). Laboratory Hematology Practice. John Wiley & Sons. pp. 460–. ISBN 978-1-4051-6218-0. OCLC 1039155353.
  5. ^ a b Douxfils J, Morimont L, Bouvy C (November 2020). "Oral Contraceptives and Venous Thromboembolism: Focus on Testing that May Enable Prediction and Assessment of the Risk". Semin Thromb Hemost. 46 (8): 872–886. doi:10.1055/s-0040-1714140. PMID 33080636. S2CID 224821517.
  6. ^ a b Hemelaar M, van der Mooren MJ, Rad M, Kluft C, Kenemans P (September 2008). "Effects of non-oral postmenopausal hormone therapy on markers of cardiovascular risk: a systematic review". Fertil Steril. 90 (3): 642–72. doi:10.1016/j.fertnstert.2007.07.1298. PMID 17923128.
  7. ^ a b c Chen, Qian; Shou, Weiling; Wu, Wei; Wang, Geng; Cui, Wei (July 2019). "Performance evaluation of thrombomodulin, thrombin‐antithrombin complex, plasmin‐α2‐antiplasmin complex, and t‐PA: PAI‐1 complex". Journal of Clinical Laboratory Analysis. 33 (6). doi:10.1002/jcla.22913. ISSN 0887-8013. PMC 6642299.
  8. ^ a b c d e Redondo, M.; Carroll, V. A.; Mauron, T.; Biasiutti, F. Demarmels; Binder, B. R.; Lämmle, B.; Wuillemin, W. A. (January 2001). "Hemostatic and fibrinolytic parameters in survivors of myocardial infarction: a low plasma level of plasmin–α2-antiplasmin complex is an independent predictor of coronary re-events:". Blood Coagulation and Fibrinolysis. 12 (1): 17–24. doi:10.1097/00001721-200101000-00003. ISSN 0957-5235.
  9. ^ Hellgren M (April 2003). "Hemostasis during normal pregnancy and puerperium". Semin Thromb Hemost. 29 (2): 125–30. doi:10.1055/s-2003-38897. PMID 12709915.
  10. ^ Lippi G, Plebani M, Franchini M, Guidi GC, Favaloro EJ (October 2009). "Prostate-specific antigen, prostate cancer, and disorders of hemostasis". Semin Thromb Hemost. 35 (7): 654–64. doi:10.1055/s-0029-1242719. PMID 20013532.



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