Subscribe to RSS
DOI: 10.1055/s-0038-1660104
Postoperative Changes in the Plasmatic Levels of Tissue-Type Plasminogen Activator and Its Fast-Acting Inhibitor - Relationship to Deep Vein Thrombosis and Influence of Prophylaxis
Publication History
Received 09 May 1985
Accepted 30 August 1985
Publication Date:
19 July 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/198503/lookinside/thumbnails/10-1055-s-0038-1660104-1.jpg)
Summary
Fibrinogen, euglobulin lysis time (ELT), tissue-type plasminogen activator (t-PA) antigen, plasminogen activator inhibitor activity (PA-inhibitor) and α2-antiplasmin (a2-AP) were measured pre- and postoperatively in 60 patients undergoing total hip replacement. Reduced fibrinolytic activity as assessed by the prolongation of euglobulin lysis time, decrease of t-PA and increase of PA-inhibitor and β2-AP could be demonstrated. These changes did not correlate with the postoperative deep vein thrombosis (DVT) diagnosed with the 125I-fibrinogen test. However, preoperative PA-inhibitor activity was significantly higher in patients with postoperative DVT (p <0.01). The prophylactic treatment with aspirin (20 patients) and with heparin plus dihy-droergotamine (20 patients) induced significant changes in some of those parameters.
This study shows that the decrease of t-PA and the increase of PA-inhibitor may contribute to the reduced postoperative fibrinolytic activity after total hip replacement. PA-inhibitor level might be a useful marker in evaluating the risk of developing DVT in patients undergoing total hip replacement.
-
References
- 1 Vermylen JG, Chamone DA F. The role of the fibrinolytic system in thromboembolism. Progr Cardiovasc Dis 1979; 31: 255-266
- 2 Sautter RD, Myers WO, Ray III JF, Wenzel FJ. Relationship of the fibrinolytic system to postoperative thrombotic phenomena. Arch Surg 1973; 107: 292-296
- 3 MacIntyre IM C, Webber RG, Crispin JR, Jones DR B, Wood JK, Allan NC, Prescott RJ, Ruckly CV. Plasma fibrinolysis and postoperative deep vein thrombosis. Br J Surg 1976; 63: 694-697
- 4 Knight MT N, Dawson R, Melrose DG. Fibrinolytic response to surgery. Labile and stable patterns and their relevance to postoperative deep vein thrombosis. Lancet 1977; 1: 370-373
- 5 Sue-Ling HM, Davies JA, Prentice CRM, Verheijen JH, Kluft C. Effects of oral stanozolol used in the prevention of postoperative deep vein thrombosis on fibrinolytic activity. Thromb Haemostas 1985; 53: 141-142
- 6 Kluft C, Verheijen JH, Cooper P, Chang GT G, Jie AF H, Blarney SL, Lowe GD O, Forbes CD, Preston FE. Post-operative changes in the activity in blood of extrinsic (tissue-type) plasminogen activator and its fast-acting inhibitor. Haemostasis 1984; 14: 41 (Abstr)
- 7 Sue-Ling HM, Davies JA, McMahon MJ, Johnston D, Philips PR, Anderson JA, Bertina RM, Verheijen JH, Kluft C. Indicators of depressed fibrinolytic activity in prediction of postoperative deep vein thrombosis. Haemostasis 1984; 14: 176 (Abstr)
- 8 Chmielewska J, Ranby M, Wiman B. Evidence for a rapid inhibitor to tissue plasminogen activator in plasma. Thromb Res 1983; 31: 427-436
- 9 Verheijen JH, Chang GT G, Mullaart E. Inhibition of extrinsic (tissue-type) plasminogen activator by human plasma: evidence for the occurrence of a fast-acting inhibitor. Thromb Haemostas 1983; 50: 294 (Abstr)
- 10 Kruithof EK O, Ransijn A, Bachmann F. Inhibition of tissue plasminogen activator by human plasma. In: Progress in Fibrinolysis Davidson JF, Bachmann F, Bouvier CA, Kruithof EK O. (Eds) Churchill Livingstone; Edinburgh: 1983. VI 365-9
- 11 Juhan-Vague I, Moerman B, De Cock F, Aillaud MF, Collen D. Plasma levels of a specific inhibitor of tissue-type plasminogen activator (and urokinase) in normal and pathological conditions. Thromb Res 1984; 33: 523-530
- 12 Colucci M, Paramo JA, Collen D. Generation in plasma of a fast-acting inhibitor of plasminogen activator in response to endotoxin stimulation. J Clin Invest 1985; 75: 818-824
- 13 Kakkar VV. The diagnosis of deep vein thrombosis using the U5l-fibrinogen test. Arch Surg 1972; 104: 152-159
- 14 Blomback B, Blomback M. Purification of human and bovine fibrinogen. Ark Kemi 1956; 10: 415-428
- 15 Deutsch DG, Mertz ET. Plasminogen: purification from human plasma by affinity chromatography. Science 1970; 170: 1095-1096
- 16 Verheijen JH, Mullaart E, Chang GT G, Kluft C, Wijngaards G. A simple, sensitive spectrophotometric assay for extrinsic (tissue-type) plasminogen activator applicable to measurements in plasma. Thromb Haemostas 1982; 48: 266-269
- 17 Clauss A. Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta Haematol 1957; 17: 237-243
- 18 Von Kaulla KN, Schultz RL. Methods for the evaluation of human fibrinolysis. Studies with two combined techniques. Am J Clin Pathol 1958; 29: 104-109
- 19 Teger-Nilsson AC, Friberger P, Gyzander E. Determination of a new rapid plasmin inhibitor in human blood by means of a plasmin specific tripeptide substrate. Scan J Clin Lab Invest 1977; 37: 403-409
- 20 Rijken DC, Juhan-Vague I, De Cock F, Collen D. Measurement of human tissue-type plasminogen activator by a two-site immunoradiometric assay. J Lab Clin Med 1983; 101: 274-284
- 21 Dixon WJ. BMDP statistical software. University of California; Los Angeles: 1981
- 22 Mellbring G, Dahlgren S, Reiz S, Wiman B. Fibrinolytic activity in plasma and deep vein thrombosis after major abdominal surgery. Thromb Res 1983; 32: 575-584
- 23 Taberner DA, Poller L, Burslem RW. Antiplasmin concentrations after surgery: Failure of a2-antiplasmin to rise in patients with venous thrombosis. Br Med J 1979; 1: 1122-1123
- 24 Mellbring G, Nilsson T, Bergsdorf N, Wallen P. Tissue plasminogen activator concentrations in major abdominal surgery. Relationship to postoperative deep vein thrombosis. Thromb Res 1984; 36: 331-334
- 25 Menon IS. Aspirin and blood fibrinolysis. Lancet 1970; 1: 364
- 26 Moroz LA. Increased blood fibrinolytic activity after aspirin ingestion. N Engl J Med 1977; 296: 525-529
- 27 Ghezzo F, Trinchero P, Pegoraro L. Effects of aspirin treatment upon fibrinolytic activity of peripheral blood granulocytes. Acta Haematol 1981; 65: 229-232
- 28 Zimmerman R, Thieesen M, Mori H, Weckesser G. The paradoxical thrombogenic effect of aspirin in experimental thrombosis. Thromb Res 1979; 16: 843-846
- 29 Levin RI, Harpel PC, Weil D, Chang TS, Rifkin DB. Aspirin inhibits vascular plasminogen activator activity in vivo. Studies utilizing a new assay to quantify plasminogen activator activity. J Clin Invest 1984; 74: 571-580
- 30 Collen D, Semeraro N, Telesforo P, Verstraete M. Inhibition of plasmin by antithrombin-heparin complex. Br J Haematol 1978; 39: 101-110
- 31 Vairel GE, Brouty-Borge H, Toulermonde F, Doutremepuich C, Marsh NA, Gaffney PJ. Heparin and a low-molecular weight fraction enhance thrombolysis and by this pathway exercise a protective effects against thrombosis. Thromb Res 1983; 30: 219-224
- 32 Vinazzer H, Sternberger A, Haas S, Blumel E. Influence of heparin, of different heparin fractions, and of a low molecular weight heparinlike substance on the mechanism of fibrinolysis. Thromb Res 1982; 27: 341-351