A. Estelles et al., ALTERATIONS IN FIBRINOLYTIC AND PROTEIN-C PATHWAYS IN GYNECOLOGICAL SURGERY - LOW-MOLECULAR-WEIGHT HEPARIN-PROPHYLAXIS, Haemostasis, 24(4), 1994, pp. 252-260
Several parameters of fibrinolytic and protein C pathways were evaluat
ed in three groups of patients with high (HR), moderate (MR) and low (
LR) postoperative thrombotic risk undergoing major gynaecological surg
ery. The HR and MR groups were subjected to low molecular weight hepar
in (LMW) prophylaxis. A significant increase in plasminogen activator
inhibitor type 1 (PAI-1) antigen and activity levels was observed in t
he HR patient group in comparison with the MR and LR groups in the pre
operative and early postoperative period. In all the groups studied, t
he maximum increase in the levels of PAI-1 was seen on day 1 after sur
gery. However, the D-dimeric levels reached the highest level on day 7
. A significant increase in activated protein C:alpha(1)antitrypsin (A
PC:alpha(1)AT) complex levels was observed in the HR group in comparis
on with the LR group, and a strong decrease in protein C inhibitor in
the early postoperative period was detected in all the groups. In spit
e of heparin prophylaxis, 2 HR patients were diagnosed as deep vein th
rombosis (DVT) during the postoperative period. Both patients showed p
re-operative levels of PAI-1 antigen or activity and APC:alpha(1)AT co
mplexes above the mean + 1 SD of the pre-operative levels in the HR gr
oup. In conclusion, in HR patients a hypofibrinolytic and hypercoagula
ble state was detected in the pre-operative and early postoperative pe
riods. The prophylactic LMW heparin dose used in the present report (2
0 mg/day x 7) was insufficient to prevent DVT in the HR group. At pres
ent our HR patients are given higher doses of LMW heparin (40 mg/day x
7).