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Human intraperitoneal fibrinolytic response to elective surgery
D Scott-Coombes1, S Whawell, M N Vipond
1Department of Surgery, Royal Postgraduate Medical School, London, UK.
The British Journal of Surgery
|March 1, 1995
Summary
Postoperative peritoneal fluid shows reduced fibrinolytic activity due to increased plasminogen activator inhibitors (PAI-1 and PAI-2). This inhibition of fibrinolysis may promote the development of intra-abdominal adhesions after surgery.
Area of Science:
- Surgical pathology
- Hemostasis and thrombosis
- Peritoneal fluid analysis
Background:
- Intra-abdominal adhesions affect over 90% of patients post-laparotomy.
- Peritoneal fibrinolysis plays a key role in adhesion formation.
- Understanding the postoperative fibrinolytic response is crucial.
Purpose of the Study:
- To investigate the fibrinolytic activity in peritoneal fluid after elective laparotomy.
- To determine the levels of key fibrinolytic components and inhibitors.
Main Methods:
- Analysis of peritoneal fluid from 12 patients undergoing elective laparotomy.
- Measurement of plasminogen activating activity, tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), and PAI-2 at 2, 6, 24, and 48 hours postoperatively.
Main Results:
- A significant reduction in plasminogen activating activity was observed at 24 and 48 hours post-surgery.
- Tissue plasminogen activator (t-PA) levels decreased early postoperatively.
- Marked increases in plasminogen activator inhibitor-1 (PAI-1) and PAI-2 concentrations were noted, correlating with reduced fibrinolytic activity.
Conclusions:
- The postoperative decrease in peritoneal fluid fibrinolytic activity is primarily driven by elevated PAI-1 and PAI-2 levels.
- This impaired fibrinolysis likely contributes to the formation of permanent fibrous adhesions following surgical procedures.
- Targeting PAI-1 and PAI-2 may offer therapeutic strategies to prevent adhesion formation.