title: The dynamics and clinical significance of alpha 2 plasmin inhibitor-plasmin complex and thrombin-antithrombin complex in postoperative pleural effusion following a pulmonary lobectomy.
abstract: OBJECTIVE
  The overall incidence of postoperative alveolar air leakage (AAL) remains high; however, the mechanism regarding how to adequately heal such postoperative AAL remains to be elucidated. The aim of this study was to determine any correlations between the activity of the fibrinolytic and coagulation system in the postoperative pleural effusion and appearance or disappearance of postoperative AAL.
  
  
  METHODS
  This study prospectively investigated 25 patients who underwent a pulmonary lobectomy from July 2005 to March 2006. Pleural effusion was collected through the chest tube. Alpha 2 plasmin inhibitor-plasmin complex (PIC), as a fibrinolytic marker, and thrombin-antithrombin complex (TAT), as a coagulation marker, were measured.
  
  
  RESULTS
  The activity of the coagulation system was higher than that of the fibrinolytic system. The concentration of TAT tended to increase (3rd vs 4th postoperative day [POD], P = 0.0907). The mean time of appearance and disappearance of postoperative AAL was 1.4 days and 3.2 days, respectively. The patients with postoperative AAL had a TAT level significantly below the average on the 3rd POD in comparison to the patients without postoperative AAL (P = 0.0163). Moreover, the concentration of TAT in patients with postoperative AAL was significantly lower than that in patients without postoperative AAL (1824.0 +/- 137.3 ng/ml vs 3444.0 +/- 287.6 ng/ml, P = 0.0113) on the 3rd POD. On the 4th POD, the concentration of TAT was almost same and there was no significance (P = 0.6759).
  
  
  CONCLUSIONS
  This study demonstrated for the first time the course of the fibrinolytic and coagulation activity in the pleural effusion after a pulmonary lobectomy, and showed that the delayed activity of the coagulation system is associated with the appearance of the postoperative AAL.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Shoji
authors.forename: Tokujiro
authors.initials: T
authors.lastname: Yano
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yoshino
authors.forename: Daigo
authors.initials: D
authors.lastname: Kawano
authors.forename: Tomoyoshi
authors.initials: T
authors.lastname: Takenaka
authors.forename: Naoko
authors.initials: N
authors.lastname: Miura
authors.forename: Kensaku
authors.initials: K
authors.lastname: Ito
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Morodomi
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara