J.Jpn. Surg. Soc.. 91(9): 1191-1195, 1990

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Report on the annual meeting

PEROPERATIVE CHANGES OF COAGULATION AND FIBRINOLYSIS AFTER ABDOMINAL SURGERY

To evaluate the response of coagulation and fibrinolysis after operation, hemostatic parameters were measured using recently devised laboratory assays of groups including cholecystectomy, gastrectomy, colectomy and hepatectomy. During operation a hypercoagulable state was confirmed from the finding of increased levels of fibrinopeptide A (FPA) and thrombin-antithrombin III complex (TAT), of which increases were comparable to the extent of operative injury and continued until early postoperative periods. On the other hand, increased levels of tissue plasminogen activator (tPA) with transient acceleration of euglobulin lysis time (ELT) were observed during operation, but plasminogen activator inhibitor (PAI-1) increased more significantly and then supervened a reduced fibrinolytic activity without increase of plasmin-α₂-plasmin inhibitor complex (PIC), which continued until early postoperative periods. The most prominent feature of postoperative period was seondary accelerated fibrinolysis which are characterized by the findings of increased levels of PIC, fibrinopeptide Bβ15-42 and high molecular weight FDP. Additionally marked increase of acute phase reactant such as fibrinogen, α₁-antitrypsin and factor VIII was observed in this period. These peroperative changes of the parameters of coagulation and fibrinolysis were affected by the extent of operative injury and several clinical conditions such as liver cirrhosis, infection, advanced cancer and other complications.

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