Indicators of depressed fibrinolytic activity in pre-operative prediction of deep venous thrombosis

Abstract Euglobulin lysis time (ELT), tissue plasminogen activator (tPA), and the fast-acting inhibitor of tPA, were measured pre-operatively in 128 patients who underwent elective major abdominal surgery. Deep venous thrombosis (DVT) was detected by 125I-labelled fibrinogen scan in 37 patients (29 per cent) after operation. Pre-operatively, there was diminished euglobulin lysis activity (332 ± 197 versus 255 ± 156 min, mean ± s.d.; P <0·025), and tissue plasminogen activator activity (4·2 ± 9·9 versus 7·7 ± 14·3 milliunits/ml, mean ± s.d.; P = 0·094) in patients who subsequently developed postoperative DVT compared with those who did not. There was no significant difference between the two groups in the level of inhibition of tissue plasminogen activator (160·6 ± 75·4 per cent versus 152·5 ± 77·5 per cent, mean ± s.d.; n = 47). Stepwise logistic discriminant analysis of the data obtained pre-operatively showed that tissue plasminogen activator, a more specific measure of fibrinolytic activity, was a weaker predictor of DVT than euglobulin lysis time. The results confirm other observations which indicate that lowered fibrinolytic activity is a risk factor for postoperative DVT. In addition, they suggest that this is not due entirely to low levels of activity of tissue plasminogen activator in plasma.