Lack of correlation between blood fibrinolysis and the immediate or post-operative blood loss in transurethral resection of the prostate

Objective: To evaluate whether the activation of the extrinsic tissue-type plasminogen activator-related fibrinolysis is implicated in the blood loss in patients with benign prostatic hyperplasia, undergoing transurethral prostatic resection (TURP). Patients and methods: TURP was performed in 24 men and the operative and post-operative blood loss determined. The activation of the tissue-type plasminogen activator-related fibrinolysis was followed using new sensitive and specific assays, and the changes related to the blood loss. Measurements of the plasma concentrations of free tissue-type plasminogen activator (t-PA) activity, tissue-type plasminogen activator (t-PA) antigen, plasminogen activator inhibitor (PAI) activity, plasminogen activator inhibitor 1 (PAI-1) antigen, plasminogen (Plg) activity, plasminogen (Plg) antigen, α₂-antiplasmin (α₂-AP), D-dimer and fibrin degradation products (FbDP) were all determined and the area under the curve (AUC) for each of these quantities correlated with the blood loss. Results: TURP was followed by a marked activation of the fibrinolytic system. There was an immediate increase in systemic t-PA activity and t-PA antigen, coinciding with a significant drop in PAI activity. Postoperatively, PAI activity and PAI-1 antigen increased. The formation of plasmin was indicated by a fall in the plasma concentration of Plg activity and Plg-antigen and α₂-AP but which increased significantly at the end of the study period. Increased systemic fibrinolytic activity was further confirmed by a marked increase in fibrin D-dimer and FbDP. There was no correlation between the AUC in the operative period of any of the fibrinolytic variables and the measured blood loss. In the post-operative period, t-PA antigen (P = 0.004), PAI activity (P = 0.043), PAI-1 antigen (P = 0.016) and α₂-AP (P = 0.047) all correlated with the post-operative blood loss, while there was no correlation between fibrin D-dimer or FbDP and blood loss. Conclusion: The fibrinolytic system is activated during and after TURP, but the increased activity is not of pathophysiological importance for the blood loss.