Invited critical review Fibrinolytic system in preeclampsia M.B. Pinheiro a, b , K.B. Gomes a , L.M.S. Dusse a, ⁎ a Department of Clinical and Toxicological Analysis, Faculty of Pharmacy/Universidade Federal de Minas Gerais, Brazil b School of Medicine, Universidade Federal de São João Del Rei, Brazil abstract article info Article history: Received 23 July 2012 Received in revised form 11 October 2012 Accepted 21 October 2012 Available online 15 November 2012 Keywords: Preeclampsia Fibrinolysis Coagulation Pregnancy Preeclampsia (PE) is a multi-system disorder of human pregnancy characterized by hypertension and proteinuria. Although its pathogenesis is not fully understood, predisposition to endothelial dysfunction is thought to play a crucial part. Normotensive pregnancy is associated with increases in coagulation factor levels and decreases in nat- ural anticoagulation, leading to a hypercoagulable state. This state is thought to be part of a complex physiological adaptation, which ensures rapid and effective control of bleeding from the placental site at the time of placental sep- aration. In PE, a more pronounced exacerbation of the hypercoagulable state is noticed, compared to normotensive pregnancy. Activation of coagulation in PE occurs at an early stage of the disease and often antedates the clinical symptoms. It is known that PE is associated with fibrin deposition in the kidney glomerulus, and in fatal cases, wide- spread fibrin deposition has been a prominent histological finding. Related to the fibrinolytic system in PE, the state of the art allows the assumption that blood coagulation overlaps the fibrinolytic regulatory mechanism, since fibrin deposition in maternal microcirculation is usually found in PE. However, there is still no consensus about its specific role. This review aims to discuss the fibrinolytic system in PE and its potential implications to the pathogenesis of this disease. © 2012 Elsevier B.V. All rights reserved. Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 1.1. Preeclampsia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 1.2. Fibrinolytic system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 1.3. Fibrinolysis in normal pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 1.4. Fibrinolysis in preeclampsia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 2. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 1. Introduction 1.1. Preeclampsia Preeclampsia (PE) is a multi-system disorder of human pregnancy, potentially dangerous for both mother and fetus [1]. PE is characterized by hypertension blood pressure ≥140/90 mm Hg on at least two con- secutive occasions 4 h apart and proteinuria (either ≥300 mg protein per day) occurring after the 20th week of pregnancy in women who have had no previous symptoms [2]. Normotensive pregnancy is associated with increases in coagulation factor levels and decreases in natural anticoagulation, leading to a hypercoagulable state [3–5]. This state is thought to be part of a com- plex physiological adaptation, which ensures rapid and effective control of bleeding from the placental site at the time of placental separation. In addition, it allows the expansion of the maternal and fetal circulation at the uteroplacental interface during pregnancy [5, 6]. PE is also associat- ed with an increased hypercoagulable state [7–9]. Fibrin deposition in the intervillous space and placental infarction has been a prominent histological finding [10]. Although PE pathogenesis is not fully under- stood, predisposition to endothelial dysfunction is thought to play a Clinica Chimica Acta 416 (2013) 67–71 ⁎ Corresponding author at: Department of Clinical and Toxicological Analysis, Faculty of Pharmacy/UFMG, Av Antonio Carlos, 6627, Pampulha, CEP: 31270-901, Belo Horizonte, MG, Brazil. Tel.: +55 31 3409 6880x6900; fax: +55 31 3409 6985. E-mail addresses: lucim@farmacia.ufmg.br, lucidusse@gmail.com (L.M.S. Dusse). 0009-8981/$ – see front matter © 2012 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.cca.2012.10.060 Contents lists available at SciVerse ScienceDirect Clinica Chimica Acta journal homepage: www.elsevier.com/locate/clinchim