Postoperative changes in plasma tissue-type plasminogen activator and type 1 plasminogen activator inhibitor.
To clarify the changes which occur postoperatively in intravascular fibrinolysis, plasma levels of tissue-type plasminogen activator (t-PA) antigen, the total plasminogen activator inhibitor type-1 (PAI-1) antigen, and the t-PA-PAI-1 complexes were assayed in this study. Blood samples were taken the morning before surgery, then at 0, 12, 24, 36, 60, 108, and 156 h postoperatively in ten patients who underwent radical surgery for thoracic esophageal cancer. The plasma levels of the t-PA and total PAI-1 antigens, and the t-PA-PAI-1 complexes were then measured by enzyme immunoassay. The plasma t-PA and total PAI-1 levels increased significantly in the immediate postoperative period, the percent increase of the latter being much greater than that of the former. Moreover, the calculated free t-PA antigen level was decreased throughout the postoperative period, suggesting postoperative hypofibrinolysis. The platelet count and neutrophil elastase level were significantly correlated with the free t-PA antigen level at r = 0.630, P < 0.001, and r = -0.447, P < 0.01, respectively. The results of this study indicated that post-operative hypofibrinolysis caused by the increased synthesis of PAI-1 may enhance postoperative hypercoagulability, and this may lead to the development of organ damage. Thus, the concentration of the PAI-1 antigen may be a potentially important index for the prediction of postoperative illness.
Aoki
K
K
Department of Emergency Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan.
Nishino
N
N
Baba
S
S
Urano
T
T
Takada
A
A
D000368:Aged; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D004938:Esophageal Neoplasms / Q000601:surgery; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D007124:Immunoenzyme Techniques; D019272:Leukocyte Elastase / Q000097:blood; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009504:Neutrophils / Q000201:enzymology; D010196:Pancreatic Elastase / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood*; D010976:Platelet Count; D011183:Postoperative Complications / Q000175:diagnosis; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000097:blood*
D017395:Plasminogen Activator Inhibitor 1; D010196:Pancreatic Elastase; D019272:Leukocyte Elastase; D010959:Tissue Plasminogen Activator