In vivo effect of proton-pump inhibitors on gastric plasmin-dependent fibrinolysis: a study in a porcine model.
BACKGROUND
Alkalization of gastric fluids could inhibit plasmin-mediated and/or pepsin-mediated fibrinolysis. We evaluated the gastric antifibrinolytic effect of proton pump inhibitors in a live porcine model.


METHODS
Six pigs were randomly assigned to treatment with proton pump inhibitors vs no treatment. After endoscopic mucosal resection, 8 μm sections were incubated on fibrin films. Fibrinolytic activity was assessed through focal lysis time. One-hundred-and-forty-two mucosal sections and 129 submucosal sections were analysed. Twenty-four additional sections were analysed on plates containing tranexamic acid to explore pepsin-mediated fibrinolysis.


RESULTS
Focal lysis times in treated vs control groups were 21.0 min vs 21.2 min (p = 0.39) in the mucosa, and 22.2 min vs 20.2 min (p = 0.56) in the submucosa. No lysis could be seen on the plasmin-inhibited fibrin plates.


CONCLUSIONS
Only plasmin-mediated fibrinolysis was observed. Proton pump inhibitors had no significant plasmin-dependant antifibrinolytic effect. They may enhance haemostasis through different pathways.
Department of Digestive Diseases, and School of Surgery, Denis Diderot, Paris 7 University, and AP-HP, Paris, France.
Aurelie
A
Thibault
Philippe
P
Marteau
Ludovic
L
Drouet
Anne
A
Lavergne Slove
Claire
C
Bal dit Sollier
Marine
M
Camus
Xavier
X
Dray
D000284:Administration, Oral; D000818:Animals; D015415:Biomarkers / Q000378:metabolism; D004334:Drug Administration Schedule; D064098:Esomeprazole / Q000008:administration & dosage / Q000494:pharmacology*; D005341:Fibrinolysin / Q000378:metabolism; D005342:Fibrinolysis / Q000187:drug effects*; D005753:Gastric Mucosa / Q000187:drug effects* / Q000378:metabolism; D006863:Hydrogen-Ion Concentration; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D011897:Random Allocation; D034421:Sus scrofa
D015415:Biomarkers; D054328:Proton Pump Inhibitors; D005341:Fibrinolysin; D064098:Esomeprazole