Levels of fibrinolytic activators and inhibitors in plasma after severe trauma.

Levels of tissue plasminogen activator antigen (t-PA:ag), tissue plasminogen activator inhibitor 1 antigen (PAI-1:ag) and tissue plasminogen activator inhibitor activity (PAI activity), and alpha-2-antiplasmin (AAP) were measured in plasma from 19 patients with severe trauma on admission and on days 1, 2, 3 and 7 after the incident. In all patients the Injury Severity Score (ISS) and the number of blood transfusions were recorded. The development of post-traumatic pulmonary dysfunction was observed in four patients. Levels of t-PA:ag, PAI-1:ag and PAI activity were increased, and levels of AAP were low immediately after trauma. Levels of t-PA:ag normalized during the first week, whereas PAI-1:ag levels decreased gradually from day 1 to day 3. Thereafter a secondary increase was observed. A similar trend was observed in levels of PAI activity. Levels of APP increased significantly during the first week. t-PA:ag, PAI-1:ag or PAI activity levels were not correlated with the ISS on any day, but levels of AAP showed a weak correlation with the ISS on day 7. Post-traumatic levels of t-PA:ag and PAI-1:ag were higher in patients who had 6 or more units of blood transfusions for resuscitation. The fibrinolytic markers were not significantly different in patients who had pulmonary dysfunction compared with patients without.