Tissue plasminogen activator and its inhibitor following major surgery in relation to ventilatory pattern

Based on animal data it has been hypothesised that lungs may regulate systemic fibrinolysis. To test this hypothesis 12 patients undergoing infrarenal aortic reconstruction due to arteriosclerotic disease were evaluated for influence of the respiratory pattern on release of tissue plasminogen activator (t-PA) and its inhibitor (PAI) in systemic and pulmonary arterial blood. Blood samples were drawn simultaneously from the pulmonary artery and a radial artery at defined times before and during surgery. Samples were also collected during application of positive end expiratory pressure (PEEP) of 5, 10 and 15 cmH2O. The blood samples were analysed for euglobulin clot lysis time (ECLT), t-PA activity, t-PA antigen and PAI. ECLT was not altered during surgery and t-PA activity was below the detectable limit. Before surgery t-PA antigen was 14.5 +/- 1.3 ng/ml and PAI 15.1 +/- 2.8 U/ml (mean +/- SEM). PAI was significantly elevated at end of surgery. There were no differences between samples from systemic and pulmonary arteries. Following application of 5, 10 and 15 cmH2O PEEP the fibrinolytic parameters were unchanged. Thus, in the present study on arteriosclerotic patients undergoing abdominal aortic reconstructions no influence from the respiratory pattern on systemic fibrinolysis could be demonstrated.