A role for the fibrinolytic system in postsurgical adhesion formation
article
To look for evidence of a fibrinolytic insufficiency as a cause of adhesion formation. Retrospective and prospective study. University medical center. Retrospective study: 50 patients undergoing laparoscopy, divided into patients with and without endometriosis. Prospective study: 18 patients undergoing infertility surgery involving a second-look laparoscopy. During all surgical procedures, adhesions were scored, and peritoneal fluid and plasma were collected. Parameters of the fibrinolytic system were measured to establish a possible relation with the presence and formation of adhesions. In patients with endometriosis and adhesions, significantly higher peritoneal fluid concentrations were found for plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA), and plasminogen, compared with patients with endometriosis but without adhesions. In the prospective study, initial peritoneal PAI-1 concentrations correlated significantly with the extent of adhesion formation (rs = 0.49) and adhesion-improvement scores (rs = -0.52). Also, the change in concentration of tPA and fibrinogen from the initial surgical procedure to the second-look laparoscopy correlated significantly with adhesion-improvement scores (ΔtPA: rs= 0.50; Δfibrinogen: rs = -0.64). This first prospective study in humans adds further weight to the hypothesis that adhesions are caused by an insufficiency in peritoneal fibrinolytic activity. Plasminogen activator inhibitor-1 is a potential marker for the identification of patients at risk for developing adhesions. © 2005 by American Society for Reproductive Medicine. Chemicals / CAS: fibrinogen, 9001-32-5; plasminogen activator inhibitor 1, 140208-23-7; plasminogen, 9001-91-6; tissue plasminogen activator, 105913-11-9; Fibrin Fibrinogen Degradation Products; Plasminogen Activator Inhibitor 1; Tissue Plasminogen Activator, EC 3.4.21.68
Topics
Biomedical ResearchAdhesion formationearly second-look laparoscopyendometriosisfibrinolytic systeminfertility surgerybiochemical markerfibrinogenplasminogenclinical articleconcentration (parameters)controlled studycorrelation analysisendometriosisinfertility therapyperitoneal fluidpostoperative complicationpriority journalretrospective studyrisk assessmentsurgical techniqueuniversity hospitalAdhesionsAdultAscitic FluidFemaleFibrin Fibrinogen Degradation ProductsFibrinolysisHumansLaparoscopyPlasminogen Activator Inhibitor 1Prospective StudiesRetrospective StudiesTissue Plasminogen Activator
TNO Identifier
238279
ISSN
00150282
Source
Fertility and Sterility, 83(1), pp. 122-129.
Pages
122-129
Files
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