Local Fibrinolysis as a Mechanism for Haemorrhage

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Abstract
Most human tissues and body fluids contain activators of plasminogen. The highest concentrations occur in the uterus, adrenals, lymph nodes, prostate, thyroid and meninges. The tissue fibrinolytic activity is related to the presence of vascularized connective tissue. The urine has a high fibrinolytic activity owing to its content of urokinase. The fibrinolytic activity in the tissues does not cause haemorrhage in intact tissues. However, any injury of such tissues can result in the release of activators and thereby maintain and prolong various forms of bleeding. Local fibrinolysis may thus be a contributory cause of bleedings from many organs. There is evidence that local fibrinolysis can maintain and aggravate bleeding from the uterus (certain cases of menorrhagia, after conisation, after insertion of intrauterine devices), the urinary pathways (prostatectomy, various operations on the bladder), the digestive tract (ulcerative colitis, erosive haemorrhagic gastroduodenites), oral cavity (tooth extractions) and the nasal mucosa. It has also been found that subarachnoid haemorrhage is followed by increased local fibrinolysis in the cerebrospinal fluid. It has been shown that a variety of drugs such as EACA, AMCA and PAMBA can inhibit both normal and, in certain situations, increased fibrinolytic activity in tissues and body fluids and thereby stop or suppress bleeding. * Presented at the Postgraduate Course and Workshop “Progress in Fibrinolysis” Milan, March 6–8, 1975.