INITIATION OF A FIBRINOLYTIC SYSTEM IN HEPATIC RESECTION - THE ROLES OF TISSUE-TYPE PLASMINOGEN-ACTIVATOR AND PLASMINOGEN-ACTIVATOR INHIBITOR-1

The factors related to the initiation of fibrinolysis, especially with regard to the tissue-type plasminogen activator (tPA) and the plasmin ogen activator inhibitor-1 (PAI-1), were investigated in 15 patients w ho underwent hepatic resection, and the findings were compared between those with normal livers and those with diseased livers. It was found that tPA increased before hepatic division, whereas PAI-1 increased a fter hepatic division and reached a peak immediately following the ope ration. Plasminogen decreased during hepatectomy, reaching its lowest point on postoperative day 1, and increasing later. Decreased levels o f both plasminogen and the alpha2-plasmin inhibitor were considered to be partly due to plasmin formation in the blood. Patients with a dise ased liver tended to have higher intraoperative values of euglobulin l ysis activity and higher postoperative values of plasminogen activator , but significantly lower postoperative values Of alpha2-plasmin inhib itor than those with a normal liver. The results of this study suggest that activation of the fibrinolytic system occurs both during hepatec tomy and in the early postoperative period, and that patients with a d iseased liver are prone to develop hyperfibrinolysis during hepatectom y. Moreover, the increased levels of both tPA and PAI-1 can serve as o ne of the most sensitive markers for the vital reaction against surgic al stress.