ALTERATIONS IN FIBRINOLYTIC AND PROTEIN-C PATHWAYS IN GYNECOLOGICAL SURGERY - LOW-MOLECULAR-WEIGHT HEPARIN-PROPHYLAXIS

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).