Time Course and Outcomes Associated with Transient Versus Persistent Fibrinolytic Phenotypes After Injury: A Nested, Prospective, Multicenter Cohort Study

Background Temporal changes in fibrinolytic activity after injury and their impact on outcomes remain poorly defined. We conducted a prospective, multicenter cohort study to determine the incidence of fibrinolytic phenotypes after injury and the trajectories and associated outcomes of these phenotypes over time. Methods We included adults that arrived within six-hours of injury to three American, level-1 trauma centers. Clot lysis at 30-minutes (LY-30) was measured at presentation and 3-, 6-, 12-, 24-, 48-, 72-, 96-, and 120-hours. LY-30 was used to categorize patients into the following fibrinolytic phenotypes: fibrinolysis shutdown (SD, LY-30 ≤0.8%), physiologic fibrinolysis (PHYS, LY-30 >0.8% to

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