Fig. 4

Example of patients requiring the combination of t-PA and plasminogen. Cases 27 and 28 (top two rows, Additional file 1: Table S1) demonstrated above normal values in the clot amplitude (A5, A10) and maximum clot firmness (MCF) on both FIB-test and EX-test. The first of the TPA-tests was performed according to the manufacturer’s instructions and hence contained t-PA 650 ng/mL blood. In both cases, little to no lysis occurred; hence, a LT was not registered. In the second of the TPA-tests, the t-PA dose was doubled as described in Fig. 3. In both cases, the increased t-PA dose did alter observed fibrinolysis and a LT was not registered. In the final TPA-tests on the right-hand side in cases 27 and 28, the blood was passed through a tip containing plasminogen 147 μg/mL as described in Fig. 3. In both cases, the addition of plasminogen induced clot lysis significantly shortening the LT which overall remained above normal. Case 5 (third row, Additional file 1: Table S1) demonstrates that on the standard TPA-test (650 ng/mL), the double-dose TPA-test (1.3 μg/mL) and even a triple-dose TPA-test (1.95 μg/mL), a concentration-dependent reduction in the MCF was observed but did not reach 50%, and therefore, no lysis time was registered. When plasminogen 59 μg/mL was added to the triple-dose TPA-test, a significant increase in clot lysis occurred and a LT was registered