DEPRESSION OF PERITONEAL FIBRINOLYSIS DURING OPERATION IS A LOCAL RESPONSE TO TRAUMA

Background. Peritoneal fibrinolytic capacity decreases during abdomina l operation. This may be a local effect or a part of a generalized res ponse to the procedure. Methods. Plasma and paired peritoneal biopsy s pecimens were taken at Intervals during abdominal operation, and fibri nolytic components were assayed in plasma and tissue extracts. Values are given as medial [interquartile range]. Results, In peritoneal tiss ue there was a gradual decrease of tissue-type plasminogen activator ( tPA) activity and at 90 minutes of the operation differed significantl y from that of the initial sample (1.0 [1.0] ng/mg protein, and 5.1 [6 .5] ng/mg protein, respectively, p < 0.05). The tPA activity levels at the wound were significantly lower (1.0 [1.0] ng/mg protein) at 90 mi nutes compared with a remote peritoneal site (1.8 [1.9] ng/mg protein, p < 0.05). At the wound the tPA activity correlated significantly wit h time (r = -0.48, n = 26, p < 0.01). tPA activity and antigen peaked in plasma at 30 minutes (p < 0.05) and 60 minutes (p < 0.05), respecti vely. Plasminogen activator inhibitor type 1 activity increased in pla sma during operation (p < 0.05), but was not detectable in peritoneal samples. Conclusions. The intraoperative changes in tissue tPA activit y were not consistently reflected in plasma samples. These findings su ggest that the reduction in peritoneal fibrinolysis during abdominal o peration is a local response to trauma.