What may initiate hyperfibrinolysis?

Hyperfibrinolysis is a condition characterized by an excessive breakdown of fibrin in blood clots, leading to increased bleeding risk. This process can be initiated by several factors, which include extensive surgical trauma and severe liver disease.

Extensive surgical trauma can lead to the release of tissue factor and other procoagulant substances, triggering a cascade of events that alter the hemostatic balance towards fibrinolysis. During major surgical procedures, especially those involving significant blood loss, the body's regulatory mechanisms can become overwhelmed, resulting in an imbalance that promotes excessive fibrinolysis.

Severe liver disease also plays a crucial role in this process. The liver is responsible for producing many of the proteins involved in clot formation and breakdown, including fibrinogen and plasminogen. In liver disease, the synthesis of these proteins can be impaired, leading to an altered hemostatic state. This dysfunction can lead to a tendency for fibrinolysis to dominate over coagulation, resulting in hyperfibrinolysis.

Given that both extensive surgical trauma and severe liver disease can independently contribute to the onset of hyperfibrinolysis, the combination of these factors increases the likelihood of this condition occurring. Therefore, the correct answer encompasses both causes, highlighting their significance in initiating