Fibrinolytic activity was studied in 51 patients subjected to major surgery (27 urological and 24 gynecological) without prophylaxis. Postoperative deep-vein thrombosis (DVT) was diagnosed by venography in 6 patients (11 %). Blood samples were obtained preoperatively and on days 1, 3 and 7 postoperatively. Reduced fibrinolytic activity, as determined by prolongation of euglobulin lysis time (ELT), decrease in plasminogen activators on fibrin plate and decrease in tissue-type plasminogen activator (t-PA) activity were present postoperatively. Moreover, a marked increase in short duration in fast-acting inhibitor (PA-inhibitor) levels was observed on postoperative day 1 (p < 0.001). Patients with DVT had higher fibrinogen degradation product (FDP) levels on postoperative days 3 and 7 (p < 0.02). Preoperative PA-inhibitor activity was higher (p < 0.02) in those patients who developed postoperative DVT. It is concluded that the decrease in t-PA and the increase in PA-inhibitor may contribute to the reduced postoperative fibrinolytic activity after major surgery. PA-inhibitor may represent a useful predictive marker of postoperative DVT.

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Euglobulin lysis time (ELT), euglobulin fibrinolytic activity on fibrin plate (EFA), plasminogen, tissue-type plasminogen activator (t-PA) activity and antigen, ;2-antiplasmin (α2-AP), plasminogen activator inhibitor (PAI) and fibrinogen degradation products (FDP) were determined in a group of 149 patients (mean age 57 ± 13 years, 93 male), with different malignancies (digestive 61, lung 18, urological 24, ginaecological 16, others 30). Findings were compared with those of 44 age-sex matched healthy subjects. There was a significant prolongation of ELT (p <0.003), a decrease of plasminogen (p < 0.004) and an increase of PAI (p < 0.0001) in patients as compared to controls, being similar EFA, t-PA, α2AP and FDP. No differences in any ot these parameters were found in patients with metastatic disease (n= 65) as compared with those with local disease (n= 84). As regards to tumour localization, plasminogen and t-PA decrease were more pronounced in lung malignancies and PAI increase in lung and digestive malignancies. We conclude that there is an impairment in blood fibrinolytic activity in malignancy. Reduced fibrinolysis seems to be related to localization but not to degree of tumoral activity. That might have clinical complications.