Perioperative fibrinolytic activity in cholecystectomized patients - The postoperative fibrinolytic shutdown is only a temporary event

Objective: to estimate the influence of successive steps of abdominal surge ry and of postoperative course on the components of fibrinolytic system. Design: a prospective open study. Setting: the patients were treated in medical research institute and the la boratory tests were done in postgraduate teaching hospital. Interventions: open cholecystectomy, performed in general anesthesia. Main outcome measures: the plasminogen concentration in plasma was determin ed by amidolytic method. The concentrations of t-PA antigen, PAI-1 antigen, and PAP complex antigen were measured by enzyme-linked immunosorbent assay s [ELISA]. Results: the induction of anaesthesia was followed by the decline in plasmi nogen concentration and this decline was observed until the beginning of in traperitoneal part of operation. The decrease of PAI-1 concentration was en countered also at this period of time but was significant only during surgi cal opening of abdominal wall. Both variables increased then gradually till the end of investigations, i.e. 7th postoperative day. t-PA and PAP comple x increased during the intraperitoneal part of cholecystectomy but their co ncentrations differed postoperatively. t-PA level declined but the concentr ation of PAP complex increased until the end of investigations, except of t he slight, transient decline on the Ist postoperative day. Conclusion: the early drop of plasminogen concentration cannot be explained by its conversion to plasmin. It is hypothesized that the binding of this zymogen to proteins, endothelial cells, and to subendothelial matrix may be regarded as a cause of its early decline in plasma. We suppose that the surgical maneuvers inside the peritoneal cavity during cholecystectomy resulted in the release of t-PA from endothelial cells of s ystemic circulation and it is speculated that this release is mediated by c ytokines. t-PA level decreased gradually after the end of operation, while PAP complex rose till the end of the 1st postoperative week after a slight, transient decrease on the 1st postoperative day. These latter findings can be explained by the local activation of fibrinolysis in the surgical wound : t-PA remains bound to fibrin inside this wound while plasmin, generated o n the fibrin matrix, is released into the circulation as PAP complex. The gradual increase of PAI-1 together with an enhanced production of plasm inogen, observed after cholecystectomy up to the 7th postoperative day, can be explained by a delayed systemic response to surgery.