Delayed administration of tissue plasminogen activator reduces intra-abdominal abscess formation

Archives of Surgery
D I McRitchieO D Rotstein

Abstract

Previous studies demonstrated that intraperitoneal fibrinolysis using tissue plasminogen activator (t-PA) prevented intraabdominal abscess formation in a rat fibrin clot infection model when administered simultaneously with the infecting inoculum. To more closely mimic the clinical setting, the efficacy of delayed administration of t-PA on intra-abdominal abscess formation was examined. A delay of 2, 6, and 18 hours had no effect on the rate of abscess formation but did reduce abscess size, indicating partial fibrinolysis. Since fibrin clots dehydrate in vivo, we hypothesized that a higher concentration of t-PA might be necessary to effect complete abscess resolution. High-dose t-PA (0.1 mg/mL) prevented abscess formation following a 6-hour delay and reduced mean weight following an 18-hour delay. Since heparin sodium may prevent new fibrin deposition and enhance t-PA activity, it was combined with t-PA to investigate potential synergistic effects. Despite adequate anticoagulation with heparin, no synergy with t-PA could be documented. In addition, the combination of antibiotics with t-PA did not affect its efficacy in vivo. We demonstrate that delayed administration of t-PA is effective in preventing abscess formation and may ...Continue Reading

Citations

Nov 1, 1992·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·O D Rotstein
Jul 21, 2012·Journal of Pediatric Surgery·Anna C ShawyerJacob C Langer
Sep 1, 1992·Current Problems in Surgery·S H Dougherty, R L Simmons
Aug 1, 1992·Current Problems in Surgery·S H Dougherty, R L Simmons
Jun 1, 1992·The Journal of Surgical Research·D S KuceyO D Rotstein
Mar 15, 1994·European Journal of Obstetrics, Gynecology, and Reproductive Biology·B M PijlmanH M Vemer
May 8, 2003·The British Journal of Surgery·M M P J ReijnenH van Goor
Jul 14, 2020·Clinics and Research in Hepatology and Gastroenterology·Simona TriponIulian Enescu
May 1, 1991·The Journal of Surgical Research·D S KuceyO D Rotstein

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