[Tissue plasminogen activator (T-PA) and tissue plasminogen activator inhibitor (PAI-1) in patients after head injury].

The following factors of fibrinolysis: tissue plasminogen activator (t-PA) and tissue plasminogen activator inhibitor-1 (PAI-1) play an important role in patients after trauma. Their possible mechanisms in head-injured patients remain unknown. We studied the maintenance of those markers of fibrinolysis in the plasma and cerebrospinal fluid of 19 patients after severe head injury (initially GCS less than 8 p) without intracranial haematoma. We measured changes of the level of t-PA antigen and PAI-1 activity in days 0-3, 4-6 and later. T-PA antigen level in the plasma was higher than normally (4-8 ng/ml). T-Pa was present in the cerebrospinal fluid, but its level reached only 30% of the plasma level. In the days following injury the t-PA antigen level decreased. The PAI-1 activity in the plasma was normal (0-15 IU/ml). However, its activity in csf was high and reached, 80% of the plasma level and systematically increase in the following days particularly in patients who died. PAI-1 activity can be connected with the presence of damaged brain tissue and its necrosis and its increase can be a marker of poor prognosis.