EXPRESSION AND KINETICS OF FIBRINOLYTIC COMPONENTS IN PLASMA AND PERITONEUM DURING ABDOMINAL-SURGERY

Objective: A reduced peritoneal tissue fibrinolytic capacity is though t to be pathogenetic in intra-abdominal adhesion formation. Therefore, the aim of this study was to characterize the expression of fibrinoly tic components in peritoneal tissue and peripheral blood at the beginn ing and end of abdominal surgery. Design: Peripheral blood and periton eal tissue were sampled simultaneously from consecutive patients opera ted for non-septic causes (Group 1, n = 27) or for intra-abdominal inf ections (Group 2, n = 10). Setting. Surgical department, University ho spital. Subjects. Thirty-seven surgical patients. Interventions. Abdom inal surgery. Main outcome measures: Tissue-type plasminogen activator (t-PA), urokinase-type plasminogen activator (uPA), plasminogen activ ator inhibitor type-1 (PAI-1) and the inactive complex formation betwe en t-PA and PAI-1 were assayed in plasma and peritoneal tissue extract s sampled at the beginning and end of surgery.Results: The expression of fibrinolytic components in plasma was similar in the two groups whe n surgery commenced. However, the intraoperative response was partly d ifferent. In Group 1, significant increases in t-PA antigen, PAI-I ant igen and t-PA/PAI complex were observed during surgery as opposed to G roup 2. When surgery started, Group 2 displayed a reduced fibrinolytic capacity in peritoneal tissue compared with Group 1. In the latter, t here was a rapid decline in t-PA activity, followed by an increase in uPA, PAI-1 and t-PA-PAI complex. The changes in Group 2 were similar, but attenuated. There was no correlation in concentrations of fibrinol ytic parameters between peritoneal and blood samples. Conclusion: Thes e observations provide novel insights into the early systemic and tiss ue response to surgery and may lead to new therapeutic strategies.