Depression of peritoneal fibrinolysis during operation is a local response to trauma

Abstract

Background: Peritoneal fibrinolytic capacity decreases during abdominal operation. This may be a local effect or a part of a generalized response to the procedure. Methods: Plasma and paired peritoneal biopsy specimens were taken at intervals during abdominal operation, and fibrinolytic components were assayed in plasma and tissue extracts. Values are given as median [interquartile range]. Results: In peritoneal tissue there was a gradual decrease of tissue-type plasminogen activator (tPA) activity, and at 90 minutes of the operation differed significantly 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 minutes compared with a remote peritoneal site (1.8 [1.9] ng/mg protein, p < 0.05). At the wound, the tPA activity correlated significantly with 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), respectively. Plasminogen activator inhibitor type 1 activity increased in plasma during operation (p < 0.05), but was not detectable in peritoneal samples. Conclusions: The intraoperative changes in tissue tPA activity were not consistently reflected in plasma samples. These findings suggest that the reduction in peritoneal fibrinolysis during abdominal operation is a local response to trauma. (Surgery 1998;123:539-44.)