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This study comprised 50 patients subjected to major abdominal surgery, of which 13 developed deep vein thrombosis (DVT) according to the 125I-fibrinogen test. Plasma was sampled preoperatively, for the specific analysis of tissue plasminogen activator (t-PA) before and during venous occlusion. The recently described fast t-PA inhibitor and plasmin alpha 2-antiplasmin complex (PAP) were also measured. The result of the laboratory analyses were correlated to the development of DVT. From the data obtained it is concluded that the evaluation of t-PA release during venous occlusion is a poor predictive factor for the occurrence of DVT after major abdominal surgery. The level of the t-PA inhibitor appears to be raised in these patients, but the values obtained in this material were not related to the development of postoperative DVT. Patients with elevated PAP levels, as shown previously, have a lesser tendency to develop postoperative DVT.

In a prospective study of 50 patients subjected to major abdominal surgery, the frequencies of postoperative deep vein thrombosis and pulmonary embolism were analysed. The patients were randomized to one of two groups receiving either neurolept anaesthesia or neurolept anaesthesia combined with thoracic epidural analgesia. Five patients were excluded. No special anti-thrombotic prophylaxis was administered. Deep vein thrombosis was diagnosed with the 125I-fibrinogen test and pulmonary embolism with pre- and postoperative lung perfusion scintigraphy combined with lung X-ray. Patients with positive scintigraphy were subjected to pulmonary angiography for verification of the diagnosis. Deep vein thrombosis was treated when diagnosed. The frequency of deep vein thrombosis was equal in both groups (38%). No patient with pulmonary embolism was recorded during the first seven days after operation. It is concluded that the addition of thoracic epidural analgesia to neurolept anaesthesia does not alter the postoperative frequency of deep vein thrombosis in patients subjected to major abdominal surgery. Early diagnosis and treatment of postoperative deep vein thrombosis might prevent pulmonary embolism. Problems encountered in the diagnosis of postoperative pulmonary embolism are discussed.