Use of fibrinolytic agents in the prevention of postoperative adhesion formation

Objective: To review the events leading to the formation of adhesions, to d escribe the development of fibrinolytic agents, to review more than a centu ry of research on the use of fibrinolytic agents in adhesion prevention, an d to look at future aspects of adhesion prevention. Results: A better understanding of the pathogenesis of adhesion formation h as resulted in the use of fibrinolytic agents in their prevention. Fibrinol ytic agents promote fibrinolytic activity during the early period after per itoneal trauma during which an increased formation of fibrin is seen in com bination with a deficiency of endogenous fibrinolytic activity. Initially, chemical attacks on fibrin (fibrolysin and hypertonic glucose), foreign dig estive ferments (pepsin, trypsin, and papain), and stimulation of intraperi toneal leuikocytosis (amniotic fluid) were used. Development of new thrombo lytic agents was soon followed by experiments in animal adhesion models and clinical studies to examine their antiadhesion properties. Plasmin prepara tions (plasmin, actase, and fibrinolysin) and plasmin activators (streptoki nase, urokinase, and tissue-type plasminogen activator) were found to be ef ficacious in preventing adhesion formation in the: greater part of reviewed animal and clinical studies. Conclusion(s): From the current literature, it can be concluded that postop erative intraperitoneal administration of thrombolytic agents can significa ntly decrease adhesion formation. Given the large number of experimental st udies in animals, future studies should focus on the clinical use of fibrin olytic agents in the prevention of postsurgical adhesion formation. (C) 200 0 by American Society for Reproductive Medicine.