In a previous study we have shown that plasminogen activator inhibitor (PAI) decreased in normal healthy volunteers during the day from 6.3±3.1 IU/ml (X±ISD) at 7.15 a.m. to 2.8±2.3 IU/ml at 3 p.m.The aim of the present study was to investigate the effect of major elective abdominal surgery on PAI. Eight patients received 2,500 Xal units of low molecular weight heparin (LogiparinTM) (Gr.l) and 7 patients received 3,500 Xal units of Logiparin (Gr.2). The PAI activity was measured amidolytically according to Chmielewska et al 1983.The plasma level of PAI (IU/ml) was (X±1SD):We found that PAI did not decrease during the day of surgery but the PAI level was significantly higher on the morning after surgery than the previous morning (p ‹ 0.05). The 5th postoperative day the PAI level had returned to pre-operative values in the morning, but did not decrease during the day as seen in normal volunteers. The PAI levels were not influenced by the different doses of heparin.Thus PAI was found to increase postoperatively and the normal decrease in PAI during the day seems to be abolished for at least five days after surgery.
An increased plasma level of D-dimer has been suggested as an indicator of postoperative thromboembolism (TE). We studied the D-dimer level in patients undergoing major elective abdominal surgery and in healthy volunteers to evaluate a possible value of D-dimer as a screening test for TE. 18 patients and 5 healthy volunteers were studied. The patients received low molecular weight heparin (Logiparin TM) subcutaneously once . daily for 7 days. The 125 I-fibrinogen uptake test (FUT) was done in all patients. Blood samples were taken preoperatively, postoperatively and on the postoperative day 1, 3, 4, 5 and 6. The volunteers had blood samples taken before and 4 hours after subcutaneous Logiparin injection. D-dimer was assayed by enzyme-immunoassay (Boehringer Mannheim, Elisa D-dimer, Cat.no. 998117). Results are given as median with 95% confidence limits in brackets.One patient developed deep venous thrombosis verified by phlebography. Two patients had abnormal FUT but normal phlebography. The plasma level for D-dimer in the 15 patients with normal FUT was 500 ng/ml (300-800) preoperatively. The D-dimer level increased postoperatively to 1700 ng/ml (900-3300) (p < 0.001). The following days the D-dimer level increased steadily to 4800 ng/ml (2600-6800) 6 days postoperatively. The plasma level of D-dimer in the volunteers were less than 110 ng/ml both before and after injection of Logiparin. The plasma level of D-dimer in the patient with deep venous thrombosis and the 2 patients with abnormal FUT were within the range of the patients with normal FUT.The postoperative D-dimer level was as high as that reported in patients with diagnosed thromboembolism.In conclusion, the D-dimer test does not seem to be a potential screening test for postoperative thromboembolism.
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