Increased levels of tissue plasminogen activator with a low plasminogen activator inhibitor‐1 in a patient with postoperative bleeding

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Abstract
Recurrent postoperative bleeding in a previously healthy man with a moderate prolongation of PT and PTT which did not correct with vigorous fresh‐frozen plasma infusion was identified as a unique abnormality of the fibrinolytic system: a combination of an excess of tissue plasminogen activator (t‐PA) at 300% of normal activity accompanied by a concurrent deficiency of plasminogen activator inhibitor‐1 activity (PAI‐1) of 10‐20% of normal activity. This observation underscores the potentially important regulatory role of PAI‐1 in the degree to which clinical manifestations of bleeding tendencies may occur in patients in whom an excess amount of t‐PA is expressed.