Use of fibrinolytic agents in the prevention of postoperative adhesion formation.
OBJECTIVE
To review the events leading to the formation of adhesions, to describe the development of fibrinolytic agents, to review more than a century of research on the use of fibrinolytic agents in adhesion prevention, and to look at future aspects of adhesion prevention.


RESULTS
A better understanding of the pathogenesis of adhesion formation has resulted in the use of fibrinolytic agents in their prevention. Fibrinolytic agents promote fibrinolytic activity during the early period after peritoneal trauma during which an increased formation of fibrin is seen in combination with a deficiency of endogenous fibrinolytic activity. Initially, chemical attacks on fibrin (fibrolysin and hypertonic glucose), foreign digestive ferments (pepsin, trypsin, and papain), and stimulation of intraperitoneal leukocytosis (amniotic fluid) were used. Development of new thrombolytic agents was soon followed by experiments in animal adhesion models and clinical studies to examine their antiadhesion properties. Plasmin preparations (plasmin, actase, and fibrinolysin) and plasmin activators (streptokinase, urokinase, and tissue-type plasminogen activator) were found to be efficacious in preventing adhesion formation in the greater part of reviewed animal and clinical studies.


CONCLUSIONS
From the current literature, it can be concluded that postoperative intraperitoneal administration of thrombolytic agents can significantly decrease adhesion formation. Given the large number of experimental studies in animals, future studies should focus on the clinical use of fibrinolytic agents in the prevention of postsurgical adhesion formation.
Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands. bwjh@xs4all.nl
B W
BW
Hellebrekers
T C
TC
Trimbos-Kemper
J B
JB
Trimbos
J J
JJ
Emeis
T
T
Kooistra
D005342:Fibrinolysis; D005343:Fibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005950:Glucose Solution, Hypertonic / Q000627:therapeutic use; D006801:Humans; D010960:Plasminogen Activators / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013300:Streptokinase / Q000627:therapeutic use; D015912:Thrombolytic Therapy / Q000379:methods; D000267:Tissue Adhesions / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D005950:Glucose Solution, Hypertonic; D011994:Recombinant Proteins; C087896:reteplase; D013300:Streptokinase; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator