Plasmin-α2-antiplasmin complex (PAP) is a 1:1 irreversibly formed inactive complex of the enzymeplasmin and its inhibitor α2-antiplasmin.[1][2][3][4] It is a marker of the activity of the fibrinolytic system and a marker of net activation of fibrinolysis.[5][6] Excess of the PAP complex can lead to abnormal bleeding due to enhanced clot lysis leading to a hyperfibrinolytic state.[7] The PAP complex can be useful in the determining the prognosis of a clot, but it is limited because it is measured using ELISA. [7]
Various uses of PAP as a marker
Low PAP levels can be indicative that patients with a past myocardial infarction have a higher risk of another coronary event within the following 2 years.[8] Specifically, when PAP levels are less than 100 ng/ml there was an associated 2.2-fold increase in the risk for another coronary event.[8] When the cut off is less than 100 there is a 5-fold increase in risk.[8] This marker is useful in the clinical setting as a potential way to identify patients that are at higher risk. However, there was not a significant difference between the PAP levels of patients that were on anticoagulative therapy versus patients that were not on anticoagulative therapy.[8] PAP is an independent marker for the risk of another coronary event post-MI, as the risk analysis remained constant when confounding factors (e.g. age, sex, BMI, smoking history, etc.) were controlled for.[8]
^ abDouxfils J, Morimont L, Bouvy C (November 2020). "Oral Contraceptives and Venous Thromboembolism: Focus on Testing that May Enable Prediction and Assessment of the Risk". Semin Thromb Hemost. 46 (8): 872–886. doi:10.1055/s-0040-1714140. PMID33080636. S2CID224821517.
^Hellgren M (April 2003). "Hemostasis during normal pregnancy and puerperium". Semin Thromb Hemost. 29 (2): 125–30. doi:10.1055/s-2003-38897. PMID12709915.
^Lippi G, Plebani M, Franchini M, Guidi GC, Favaloro EJ (October 2009). "Prostate-specific antigen, prostate cancer, and disorders of hemostasis". Semin Thromb Hemost. 35 (7): 654–64. doi:10.1055/s-0029-1242719. PMID20013532.
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