title: Decreased levels of PAI-1 and alpha 2-antiplasmin contribute to enhanced fibrinolytic activity in divers.
abstract: BACKGROUND
  There are a number of reported cases of decompression sickness (DCS) with haemorrhages. These cases have not been sufficiently investigated and thus bleeding complications could not be directly correlated to the enhanced fibrinolysis.
  
  
  OBJECTIVE
  The effect of hyperbaric exposition and decompression on the main components of fibrinolytic system has been measured.
  
  
  METHODS
  Two groups of 25 male divers each were subjected to hyperbaric exposures to the pressure of either 400 kPa - group I - or 700 kPa - group II followed by a staged decompression. The divers were monitored for clinical symptoms of DCS and checked for Doppler-detected venous gas bubbles. Venous blood was drawn from divers before exposition and 15 min after decompression. The concentrations and activities of t-PA and PAI-1 as well as concentrations of PAP and alpha2-antiplasmin and activity of factor XIIa were measured.
  
  
  RESULTS
  In all groups of divers no cases of DCS as well as detectable gas bubbles were noted. We observed elevated concentration of PAP, decreased concentration of alpha2-AP, decreased PAI-1 concentration and activity. There were no significant changes in factor XIIa activity as well as of t-PA concentration and activity.
  
  
  CONCLUSIONS
  Hyperbaric exposition and decompression induce activation of fibrinolysis, even in the absence of detectable gas bubbles. Fibrinolytic activity increases mainly due to decrease of PAI-1 concentration and activity. Further clinical trials are necessary for the estimation of the importance of activation of fibrinolysis with decreased level of PAI-1 and alpha2-AP as a possible risk factor for bleeding in divers.
authors.affiliation: Department of Haematology, Medical University of Białystok, Poland. piotr.radziwon@wp.pl
authors.forename: P
authors.initials: P
authors.lastname: Radziwon
authors.forename: R
authors.initials: R
authors.lastname: Olszański
authors.forename: R
authors.initials: R
authors.lastname: Tomaszewski
authors.forename: A
authors.initials: A
authors.lastname: Lipska
authors.forename: Z
authors.initials: Z
authors.lastname: Dabrowiecki
authors.forename: K
authors.initials: K
authors.lastname: Korzeniewski
authors.forename: P
authors.initials: P
authors.lastname: Siermontowski
authors.forename: B
authors.initials: B
authors.lastname: Boczkowska-Radziwon
mesh_terms: D000293:Adolescent; D000328:Adult; D003664:Decompression; D003665:Decompression Sickness / Q000097:blood* / Q000628:therapy; D004242:Diving / Q000502:physiology*; D015956:Factor XIIa / Q000378:metabolism; D005342:Fibrinolysis / Q000502:physiology*; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood / Q000378:metabolism*; D010959:Tissue Plasminogen Activator / Q000097:blood; D000979:alpha-2-Antiplasmin / Q000378:metabolism*
chemical_list: D017395:Plasminogen Activator Inhibitor 1; D000979:alpha-2-Antiplasmin; D015956:Factor XIIa; D010959:Tissue Plasminogen Activator