Endogenous fibrinolysis is a powerful natural defence mechanism against lasting arterial
thrombotic occlusion. Recent prospective studies show that impaired endogenous fibrinolysis
(or hypofibrinolysis) can be detected in a significant number of patients with acute coronary
syndrome (ACS) using global assays and is a strong marker of future cardiovascular risk.
This novel risk biomarker is independent of traditional cardiovascular risk factors and
unaffected by antiplatelet therapy. Nevertheless, the optimal test to assess endogenous
fibrinolysis is not clear. Most prospective, prognostic data have been obtained using a global
assay employing native whole blood at high shear or plasma turbidimetric assays.
For example, tests of endogenous fibrinolysis could be used to identify ACS patients who,
despite antiplatelet therapy, remain at high cardiovascular risk. Clinical trials of
pharmacotherapy to favourably modulate fibrinolytic status are required as a potential new
avenue to improve outcomes in ACS.