Venous stasis-induced fibrinolysis prevents thrombosis in mice: role of α2-antiplasmin

Satish Singh, Aiilyan Houng and Guy Reed

Key Points

  • Venous stasis activates fibrinolysis, which is ineffective because of suppression by α2-antiplasmin

  • Lack of α2-antiplasmin activity prevents thrombosis, suggesting that it is essential for venous thrombus formation


Stasis of venous blood triggers deep vein thrombosis by activating coagulation, yet its effects on the fibrinolytic system are not fully understood. We examined the relationship between stasis, fibrinolysis and the development of experimental venous thrombosis. Effects of stasis-induced deep vein thrombosis and fibrinolysis on thrombosis were examined by inferior vena cava ligation in congenic mice with and without α2-antiplasmin (α2AP), the primary inhibitor of plasmin. Venous thrombus weights were measured and thrombus composition was determined by Martius scarlet blue and immunofluorescence staining. Venous thrombi from α2AP+/+ mice contained plasminogen activators, plasminogen activator inhibitor-1, plasminogen, and α2AP, which changed with thrombus age. Normal, α2AP+/+ mice developed large, occlusive thrombi within 5 h after ligation; thrombi were even larger in plasminogen-deficient (Pg-/-) mice (P< .001). No significant thrombus formation was seen in α2AP-/- mice (P< .0001) or in α2AP+/+ mice treated with an α2AP-inactivating antibody (P< .001). Venous stasis activated fibrinolysis, measured by D-dimer levels, in α2AP-/- mice vs α2AP+/+ mice (P< .05). Inhibition of fibrinolysis by the indirect plasmin inhibitor epsilon-aminocaproic acid or by α2AP restored thrombosis in α2AP-/- mice. In addition to its effects on acute thrombosis, thrombus formation was also markedly suppressed in α2AP-/- mice vs. α2AP+/+ mice (P< .0001) 1, 7 and 14 days after ligation. We conclude that experimental venous stasis activates the fibrinolytic system to block the development of venous thrombosis. Suppression of fibrinolysis by α2AP appears essential for stasis-induced thrombus development, which suggests that targeting α2AP may prove useful for preventing venous thrombosis.

  • Submitted February 6, 2019.
  • Revision received August 8, 2019.
  • Accepted August 1, 2019.