THE EFFECTS OF GYNECOLOGICAL SURGERY ON COAGULATION ACTIVATION, FIBRINOLYSIS AND FIBRINOLYTIC INHIBITOR IN PATIENTS WITH AND WITHOUT KETOROLAC INFUSION

The effects of gynaecological surgery on the fibrinolytic and inhibito r mechanisms were followed up for 24h post-operatively in patients rec eiving a single dose of ketorolac infusion (n=18) as compared with tho se not receiving ketorolac infusion (n=11). A pre-operative state of l ower mean t-PA activity and higher PAI-1 levels with increased platele t activation than that reported in normal subjects were observed in bo th groups of patients. Increased t-PA activity upon anaesthetic induct ion together with a decreased level at 24h post-operation was seen in both groups. However, fibrinolytic 'shut-down' was not evident as sign ificant increase in D-dimer levels was observed post-operatively, sugg esting an enhanced lytic state concurrent with an enhanced activation of coagulation and diminished platelet activation although beta-TG rem ained above the normal level; plasmin from this enhanced lyric state a ffects platelet adhesion and cleaves platelet glycoprotein Ib thus inh ibit release reaction. Ketorolac infusion elicited a significant respo nse in PAI-1 activity within 24h post-operation and this was not seen in the non-ketorolac group, in spite of the rising trend by 24h post-o peration which did not achieve statistical significance. There were no statistical signifcant differences in blood loss and duration of surg ery between the two groups of patients. Overall, both groups of patien ts showed similar haemostatic changes post-operatively for 24h, a long er duration of post-operative study would have revealed any subtle cha nges in the molecular markers of thrombosis which was not the objectiv e of this study.