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Surgical stress induces acute coronary release of tissue-type plasminogen activator in the pig

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Tissue-type plasminogen activator (t-PA) is an endothelium derived key enzyme in the initiation of endogenous fibrinolysis. Acute regulated release of active t-PA occurs within minutes in response to threatening thrombotic vessel occlusion. The aim of this study was to investigate the impact of surgical stimulation on the kinetics of t-PA release in the coronary vascular bed in the pig. Methods:

In anaesthetised pigs (n=16), arterio-venous concentration gradients of t-PA, and plasma flows (retrograde thermodilution) were obtained across the coronary vascular bed before (control) and at 1, 3, 5 and 10 min after sternotomy. Results:

At control, no significant coronary net flux (release or uptake) of t-PA was observed, while sternotomy induced a rapid net release of total t-PA (132.6 ng · min−1), with an associated increase in active t-PA (93.6 ng · min−1). This response, evident already after 1 min, showed a peak at 5 min and returned towards baseline levels within 10 min. No concurrent alterations in aortic levels of active t-PA were found and haemodynamic variables were unaltered. Conclusion:

The rapidly increasing and transient net coronary release of t-PA after sternotomy suggests that the endothelium actively promotes local endogenous fibrinolysis during surgery. Such events could reflect a dynamic responsiveness to protect the coronary circulation during stress.

Keywords: Pigs; coronary circulation; fibrinolysis; net fluxes; sternotomy; tissue-type plasminogen activator

Document Type: Research Article


Affiliations: 1: Department of Surgical and Perioperative Science, Anaesthesiology and Intensive Care and 2: Department of Surgical and Perioperative Science, Cardiothoracic Surgery, Umeå University, Umeå, 3: Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Göteborg, Sweden

Publication date: November 1, 2000

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