J.Jpn. Surg. Soc.. 60(4): 632-639, 1959

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ON THE ABNORMAL BLOOD COAGULATION INDUCED BY SURGICAL STRESSOR

Studies were carried out in order to clarify the influence of surgical stressor upon the mechanism of blood coaglation, with special reference to the occurrence of abnormal blood coagulation and to its defense mechanism, by determining the coagulation time and the fibrinolytic activity of the blood following the operation. The results obtained were as follows:
In general, the coagulability of blood increased immediately by the surgical stressor, favoring the occurrence of thromboembolism, then decreased to the lowest level around the 2nd to the 4th postoperative days and returned gradually to the normal level. On the other hand, the fibrinolytic activity increased in the first period of the increased blood coagulability during surgical stress, and it decreasd around the 2nd to the 4th postoperative days. This fact may be significant in preventing the occurrence of thromboembolism or abnormal hemorrhage in the postoperative days.
The remarkable decrease of the fibrinolytic activity of blood may result from an increas of antifibrinolytic enzyme (antiplasmin) induced by hyperfunction of the adrenal cortex.
A few cases showed that the coagulability of blood increased during operations and then returned to the preoperative level soon after operation, without showing any marked changes hereafter. The changes of the fibrinolytic activity showed a similar tendency.
These results suggest that there may exist an adequate balanc between the coagulability and the fibrinolytic activity of blood, contributing to maintain a defense mechanism to prevent postoperative complications such as thromboembolism or abnormal hemorrhage.
On the other hand, there were some cases which showed an unbalance between blood coagulation and fibrinolytic activity. This condition may be regarded as a preparatory state toward postoperat ive thromboembolism or hemorrhagic complications.
In short, postoperative thromboembolism or hemorrhagic complications may be apt to occur, if the balances between coagulant and anticoagulant factors, fibrinolytic enzyme (plasmin) and antifibrinolytic enzyme (antiplasmin) are lost by the surgical stressor.
(author's abstract)

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