• C D Krohn, O Reikerås, S Bjørnsen, and F Brosstad.
• National Hospital, Centre for Orthopaedics, Oslo, Norway.
• Eur J Surg. 2001 Mar 1; 167 (3): 168-72.

ObjectiveTo evaluate the fibrinolytic activity in a closed surgical wound, in postoperatively drained blood, and during autologous transfusion.DesignProspective study.SettingNational hospital, Norway.Patients9 patients operated on for thoracic scoliosis.Main Outcome MeasureConcentrations of plasmin/antiplasmin (PAP), alpha2-antiplasmin, and D-dimers in drained, arterial, and mixed venous blood before, during, and after infusion of 10 ml/kg body weight of postoperatively drained, untreated blood.ResultsIn drained blood the concentration of alpha2-antiplasmin was 31% of the preoperative arterial control value. Together with the increased concentrations of PAP to 18076 microg/L and D-dimers to 126 mg/L, this indicates extensive fibrinolytic activity in the closed wound. The postoperative autologous transfusion of drained, untreated blood increased the concentration of PAP from 507 to 2453 microg/L and of D-dimer from 0.7 mg/L to 15.3 mg/L in systemic blood.ConclusionThe systemic concentration of fibrin(ogen) degradation products, indicated by D-dimers, after recirculation of drained, untreated blood might impair coagulation. The extensive activation of plasmin might exhaust available alpha2-antiplasmin in the wound and result in postoperative rebleeding.

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