LACK OF CORRELATION BETWEEN BLOOD FIBRINOLYSIS AND THE IMMEDIATE OR POSTOPERATIVE BLOOD-LOSS IN TRANSURETHRAL RESECTION OF THE PROSTATE

Objective To evaluate whether the activation of the extrinsic tissue-t ype plasminogen activator-related fibrinolysis is implicated in the bl ood loss in patients with benign prostatic hyperplasia, undergoing tra nsurethral prostatic resection (TURF). Patients and methods TURF was p erformed in 24 men and the operative and post-operative blood loss det ermined. The activation of the tissue-type plasminogen activator-relat ed fibrinolysis was followed using new sensitive and specific assays, and the changes related to the blood loss, Measurements of the plasma concentrations of free tissue-type plasminogen activator (t-PA) activi ty, tissue-type plasminogen activator (t-PA) antigen, plasminogen acti vator inhibitor (PAI) activity, plasminogen activator inhibitor 1 (PAI -1) antigen, plasminogen (Plg) activity, plasminogen (Plg) antigen, al pha(2)-antiplasmin (alpha(2)-AP), D-dimer and fibrin degradation produ cts (FbDP) were all determined and the area under the curve (AUG) for each of these quantities correlated with the blood loss, Results TURP was followed by a marked activation of the fibrinolytic system. There was an immediate increase in systemic t-PA activity and t-PA antigen, coinciding with a significant drop in PAI activity. Postoperatively, P AI activity and PAI-1 antigen increased. The formation of plasmin was indicated by a fall in the plasma concentration of Pig activity and Pl g-antigen and alpha(2)-AP but which increased significantly at the end of the study period. Increased systemic fibrinolytic activity was fur ther confirmed by a marked increase in fibrin D-dimer and FbDP. There was no correlation between the AUC in the operative period of any of t he fibrinolytic variables and the measured blood loss. In the post-ope rative period, t-PA antigen (P=0.004), PAI activity (P=0.043), PAI-1 a ntigen (P=0.016) and alpha(2)-AP (P=0.047) all correlated with the pos t-operative blood loss, while there was no correlation between fibrin D-dimer or FbDP and blood loss. Conclusion The fibrinolytic system is activated during and after TURF, but the increased activity is not of pathophysiological importance for the blood loss.