Use of TPA-induced clot lysis time (TCLOT) to diagnose abnormal clot structure and fibrinolysis in a patient with spontaneous bleeding into his leg

Diagnosis and treatment of patients with bleeding due to enhanced fibrinolysis is hampered by the absence of a rapid screen of fibrinolytic potential. The authors have developed a simple assay to assess clot structure and fibrinolysis in patient samples exposed to tissue plasminogen activator (TPA). They present the case of a forty-one-year-old man who presented with spontaneous bleeding despite normal results from coagulation screening tests, platelet count, platelet aggregation studies, platelet force development, and bleeding time. Evaluation of the patient's clot structure revealed a very weak, low-modulus, clot that rapidly dissolved in the presence of TPA. Identification of the abnormality allowed treatment with epsilon-aminocaproic acid with prompt resolution of bleeding.