title: The role of plasminogen activator in adhesion prevention.
abstract: The reduction in peritoneal plasminogen activator activity (believed to be the pathogenic mechanism of adhesion formation) and its replacement with recombinant tissue plasminogen activator (rt-PA) have been investigated in the prevention of initial (primary) and recurrent adhesion production. Other, potentially harmful, effects of intra-abdominal rt-PA application have also been examined. This included effects on wound and colonic healing and hemostasis. The prevention of adhesion formation was studied in primary and recurrent adhesion formation using a rabbit model. Primary adhesions formed in one of 14 occasions (7 per cent) with rt-PA compared with 12 of 15 occasions (80 per cent) with placebo (chi-square equals 15.542, p less than 0.001). Recurrent adhesions formed on two of 27 occasions (7 per cent) with rt-PA compared with 22 of 28 occasions with placebo (79 per cent) and 12 of 12 occasions with control rabbits (100 per cent, chi-square equals 40.588, p less than 0.0001). The application of rt-PA to abdominal wounds in the rabbit failed to show any reduction in wound strength at four, seven and ten days. Colonic anastomotic healing was unaltered by rt-PA at three, five and seven days. There was no difference seen in hemorrhagic events between control, placebo or rt-PA rabbits at any stage. The use of rt-PA is an exciting development in the field of adhesion prevention; it is an effective inhibitor of adhesion formation and intra-abdominal administration appears safe in a rabbit model.
authors.affiliation: Westminster Hospital, London, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Menzies
authors.forename: H
authors.initials: H
authors.lastname: Ellis
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D000818:Animals; D003106:Colon / Q000601:surgery; D004195:Disease Models, Animal; D004353:Drug Evaluation, Preclinical; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D010532:Peritoneal Diseases / Q000209:etiology / Q000517:prevention & control*; D011817:Rabbits; D011994:Recombinant Proteins / Q000627:therapeutic use; D012008:Recurrence; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014945:Wound Healing / Q000187:drug effects
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator