Aranda A, Páramo J A, Rocha E
Hematology Service, University Clinic, University of Navarra, Pamplona, Spain.
Haemostasis. 1988;18(2):129-34. doi: 10.1159/000215794.
Fibrinolytic activity was studied in 51 patients subjected to major surgery (27 urological and 24 gynecological) without prophylaxis. Postoperative deep-vein thrombosis (DVT) was diagnosed by venography in 6 patients (11%). Blood samples were obtained preoperatively and on days 1, 3 and 7 postoperatively. Reduced fibrinolytic activity, as determined by prolongation of euglobulin lysis time (ELT), decrease in plasminogen activators on fibrin plate and decrease in tissue-type plasminogen activator (t-PA) activity were present postoperatively. Moreover, a marked increase in short duration in fast-acting inhibitor (PA-inhibitor) levels was observed on postoperative day 1 (p less than 0.001). Patients with DVT had higher fibrinogen degradation product (FDP) levels on postoperative days 3 and 7 (p less than 0.02). Preoperative PA-inhibitor activity was higher (p less than 0.02) in those patients who developed postoperative DVT. It is concluded that the decrease in t-PA and the increase in PA-inhibitor may contribute to the reduced postoperative fibrinolytic activity after major surgery. PA-inhibitor may represent a useful predictive marker of postoperative DVT.
对51例未接受预防措施的接受大手术的患者（27例泌尿外科手术患者和24例妇科手术患者）的纤溶活性进行了研究。通过静脉造影术诊断出6例患者（11%）术后发生深静脉血栓形成（DVT）。在术前以及术后第1、3和7天采集血样。术后出现了纤溶活性降低，表现为优球蛋白溶解时间（ELT）延长、纤维蛋白平板上纤溶酶原激活物减少以及组织型纤溶酶原激活物（t-PA）活性降低。此外，术后第1天观察到快速作用抑制剂（PA抑制剂）水平在短时间内显著升高（p<0.001）。发生DVT的患者在术后第3天和第7天的纤维蛋白原降解产物（FDP）水平更高（p<0.02）。术后发生DVT的患者术前PA抑制剂活性更高（p<0.02）。得出的结论是，t-PA的降低和PA抑制剂的增加可能导致大手术后术后纤溶活性降低。PA抑制剂可能是术后DVT的一个有用的预测指标。
