[Changes of fibrinolysis during labour with and without aprotinin application].
OBJECTIVE
The aim of this study was to determine (a) if alpha-2-antiplasmin, plasminogen and plasminogen-activator-inhibitors (PAI 1 - 4) change in the peripartal period, (b) if these changes are explainable by the detachment of the placenta and the release of coagulation factors, and (c) if aprotinin could affect postpartal fibrinolysis when given shortly before delivery.


METHODS
84 patients have been examined (41 normal deliveries, 43 cesarean sections). After informed consent and randomization, 30 of these patients were administered 1 million KIU aprotinin (Trasylol(R)) at the latest 15 minutes before delivery (15 normal deliveries, 15 cesarean sections). The results of PAI (1 - 4), alpha-2-antiplasmin and plasminogen were collected shortly before and after delivery and 30 and 120 min after detachment of the placenta.


RESULTS
Normal deliveries and cesarean sections without aprotinin showed an evident decrease of PAI (1 - 4) after delivery while alpha-2-antiplasmin and plasminogen values did not change. After administration of aprotinin the activity of PAI (1 - 4) increased slightly after labour in normal deliveries and cesarean sections and then slowly decreased later. alpha-2-Antiplasmin levels increased post partum and then decreased to the original values. Plasminogen did not change. There were no significant differences between normal deliveries and cesarean sections with regard to the three parameters studied in this work.


CONCLUSIONS
Changes in PAI (1 - 4) and alpha-2-antiplasmin after administration of aprotinin could be the result of a minimal demand on the fibrinolytic system. Finally, aprotinin can reduce the consumption of coagulation and fibrinolysis factors induced by detachment of the placenta. This could be used in therapy and prophylactic treatment in high-risk patients (e.g., pre-eclampsia, HELLP syndrome, etc.).
Kühnert
M
M
Klinik für Geburtshilfe und Perinatalmedizin der Universitätsfrauenklinik Marburg. dres-kuehnert@t-online.de
Stein
W
W
Tekesin
I
I
Hellmeyer
L
L
Schmidt
S
S
D000328:Adult; D007611:Aprotinin / Q000008:administration & dosage*; D002585:Cesarean Section; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects* / Q000502:physiology; D006487:Hemostasis / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007743:Labor, Obstetric / Q000097:blood / Q000187:drug effects*; D010958:Plasminogen / Q000378:metabolism; D015849:Plasminogen Inactivators / Q000097:blood; D011247:Pregnancy; D011292:Premedication; D012016:Reference Values; D000979:alpha-2-Antiplasmin / Q000378:metabolism
D015849:Plasminogen Inactivators; D000979:alpha-2-Antiplasmin; D010958:Plasminogen; D007611:Aprotinin