Changes in plasmatic tissue-type plasminogen activator and plasminogen activator inhibitor activity during acute arterial occlusion associated with severe ischemia.

Severe lower limb ischemia in patients with acute arterial occlusion was associated with a significant increase in systemic fibrinolytic activity. Plasmatic level of t-PA activity was twice the normal value at the peak of ischemia. This level declined gradually within no less than 40 hours after reperfusion procedure or limb amputation had reverted the ischemic state. In spite of major tissue damage and surgical trauma, plasmatic PAI activity stayed within normal range, and did not increase within the first 24 hours postoperatively. These findings strongly suggest that acute ischemia initiates systemic induction of excessive and continuous release of t-PA, which outweighs any anticipated increase in PAI activity.