Postoperative hypercoagulable state followed by hyperfibrinolysis related to wound healing after hepatic resection.
BACKGROUND
Coagulative disorders may result from a breakdown in the balance between coagulation and fibrinolysis. It is important to assess the relative physiologic states of coagulation and fibrinolysis related to operation.


METHODS
A prospective study of 16 patients who underwent hepatic resection was performed. Coagulative and fibrinolytic activities were examined for comparison with those of patients having total thoracoesophagectomy or colorectal resection. In addition, mice underwent hepatic resection, and histologic analysis was conducted to detect local fibrinolysis.


RESULTS
In patients who underwent hepatic resection, circulating levels of thrombin-antithrombin III complex were significantly elevated during operation, whereas the levels of plasmin-alpha 2-plasmin inhibitor complex, fibrin-fibrinogen degradation products, and D-dimer were slightly elevated. After operation, the values of thrombin-antithrombin III complex decreased but plasmin-alpha 2-plasmin inhibitor complex peaked on the third postoperative day and both fibrin-fibrinogen degradation products and D-dimer increased again to reach maximum levels on postoperative day 7. Immediately after operation, the ratio of thrombin-antithrombin III complex to plasmin-alpha 2-plasmin inhibitor complex was significantly greater and the ratio of tissue-type plasminogen activator to plasminogen activator inhibitor-1 was significantly lower in patients who underwent hepatic resection than comparable ratios in patients who underwent colorectal resection. In the murine model, fibrin-like products with immunostaining of plasminogen activator inhibitor-1 were broadly deposited at the edge of the residual liver on postoperative day 5, then disappeared by postoperative day 14.


CONCLUSIONS
These findings indicate that immediately after operation the stress of hepatic resection led to extensive hypercoagulation and hypofibrinolytic activity, as compared with colorectal resection, and suggest that fibrinolysis without hypercoagulation in the late postoperative period might be caused by local fibrinolysis in the healing wound.
Tsuji
K
K
First Department of Surgery, Shiga University of Medical Science, Japan.
Eguchi
Y
Y
Kodama
M
M
D000368:Aged; D000818:Animals; D000990:Antithrombin III / Q000032:analysis; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D005260:Female; D005342:Fibrinolysis; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D051379:Mice; D008813:Mice, Inbred ICR; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000032:analysis; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis; D011184:Postoperative Period; D011446:Prospective Studies; D014945:Wound Healing / Q000502:physiology
D017395:Plasminogen Activator Inhibitor 1; C046193:antithrombin III-protease complex; D000990:Antithrombin III; D010447:Peptide Hydrolases