What does a high LY30 value on a Thromboelastography (TEG) report indicate?

High LY30 on TEG Indicates Hyperfibrinolysis

A high LY30 value on TEG indicates hyperfibrinolysis—excessive breakdown of blood clots—which is associated with increased risk of massive transfusion requirements and mortality. 1

What LY30 Measures

• LY30 represents the percentage of clot degradation occurring 30 minutes after the clot reaches its maximum strength (MA), providing a real-time assessment of how rapidly the body is breaking down formed clots 1
• This measurement captures fibrinolytic activity in whole blood, reflecting the balance between clot formation and clot breakdown 1

Critical Threshold Values

LY30 ≥3% defines clinically significant hyperfibrinolysis and represents a critical indication for antifibrinolytic therapy. 2

• Patients with LY30 ≥3% have a 90.9% risk of requiring massive transfusion compared to only 30.5% in those with LY30 <3% 2
• Mortality from hemorrhage increases dramatically to 45.5% when LY30 ≥3% versus only 4.8% when LY30 <3% 2
• The traditional upper limit of normal (7.5%) is inappropriate in severe trauma, as mortality risk rises at much lower levels of clot lysis 2
• LY30 >7.5% indicates severe hyperfibrinolysis according to guideline societies 3

Immediate Management Algorithm

When LY30 ≥3%, activate massive transfusion protocol immediately with 1:1:1 ratio of packed RBCs, FFP, and platelets. 1

For LY30 ≥10% (on TEG 6s), administer tranexamic acid (TXA) 1g IV over 10 minutes, followed by 1g infusion over 8 hours—this intervention may be life-saving. 1

• Repeat TEG 15-30 minutes after any intervention to assess response to antifibrinolytic therapy 1
• Goal-directed therapy using TEG parameters improves survival compared to conventional coagulation test-guided therapy 4

Molecular Pathophysiology

• Patients with high LY30 demonstrate elevated tissue plasminogen activator and plasmin-antiplasmin levels upon hospital arrival, confirming true fibrinolytic activation 5
• Hyperfibrinolysis is the most clinically significant form of traumatic fibrinolytic dysfunction and is associated with worse outcomes 5
• High LY30 is associated with increased 24-hour and 30-day mortality 5

Special Population Considerations

• Patients with antiphospholipid syndrome or persistent antiphospholipid antibodies demonstrate significantly increased LY30 compared to controls, reflecting enhanced fibrinolysis 1
• In pregnancy, baseline fibrinolysis is typically suppressed (LY30 near 0%), so any elevation is particularly concerning and indicates severe pathology in obstetric hemorrhage 4

Critical Pitfall: Distinguishing True Fibrinolysis from Clot Retraction

In postpartum hemorrhage specifically, an elevated kaolin TEG LY30 may represent platelet-mediated clot retraction rather than true fibrinolysis. 6

• To distinguish between these two mechanisms, obtain a functional fibrinogen TEG (which contains a platelet inhibitor) 6
• True fibrinolysis shows a nonzero functional fibrinogen TEG LY30, while platelet-mediated clot retraction shows zero functional fibrinogen TEG LY30 6
• In one study of postpartum hemorrhage, none of the patients with kaolin TEG LY30 ≥3% had detectable clot lysis on functional fibrinogen TEG, suggesting clot retraction rather than fibrinolysis 6

Device-Specific Considerations

• Results are not interchangeable between TEG and ROTEM devices—use device-specific reference ranges 1
• TEG is performed at 37°C and cannot assess effects of hypothermia on coagulation 3