PERITONEAL FIBRINOLYSIS - EVIDENCE FOR THE EFFICIENCY OF THE TISSUE-TYPE PLASMINOGEN-ACTIVATOR

  • 1 January 1983
    • journal article
    • research article
    • Vol. 101  (6) , 921-929
Abstract
Blood shed into a closed peritoneal cavity is incoagulable. This poorly understood phenomenon was investigated in animal experiments. Nonthrombogenic femoral vein-peritoneal cavity shunts were established in 5 dogs and 10 ml/kg blood admixed with 125I-dog fibrinogen was rapidly drained into the peritoneal cavity. After 1 h the peritoneal cavity was entered and incoagulable blood aspirated; 125I-fibrinogen MW distribution was assessed by AGPC [analytical gel-permeation chromatography], demonstrating complete degradation of fibrinogen into core fragments D and E with no evidence of soluble fibrin complexes or crosslinked fibrin fragments. Peritoneal cavity clotting factors II, V and VIII and platelets were sharply reduced compared to venous control samples. Plasminogen and antiplasmin levels in peritoneal cavity blood showed mean declines of 17 and 15%, respectively. By comparison, incubation of dog blood with 1-2 .times. 103 U/ml urokinase for 1 h in vitro was insufficient to degrade 125I-dog fibrinogen to core fragments D and E, although plasminogen and antiplasmin were reduced by 66 and 100%, respectively. Pretreatment of dogs with .epsilon.ACA [epsilon aminocaproic acid] (0.13 g/kg, N = 4) resulted in massive i.p. cavity clotting, and aspirated fluid blood contained only small quantities of radiolabel. Heparin treatment (300 U/kg bolus, 150 U/kg per h infusion; N = 4) eliminated the peritoneal cavity lytic response; analytical gel permeation chromatography consistently demonstrated intact fibrinogen only. Therefore it is apparent that blood in a closed peritoneal cavity undergoes limited clotting followed by brisk plasmin-mediated fibrinolysis as opposed to fibrinogenolysis. The closed peritoneal cavity fibrinolytic response to clotting blood represents a striking example of the efficiency of the tissue-type plasminogen activator.