Summary
Most human tissues and body fluids contain activators of plasminogen. The highest
concentrations occur in the uterus, adrenals, lymph nodes, prostate, thyroid and meninges.
The tissue fibrinolytic activity is related to the presence of vascularized connective
tissue. The urine has a high fibrinolytic activity owing to its content of urokinase.
The fibrinolytic activity in the tissues does not cause haemorrhage in intact tissues.
However, any injury of such tissues can result in the release of activators and thereby
maintain and prolong various forms of bleeding. Local fibrinolysis may thus be a contributory
cause of bleedings from many organs.
There is evidence that local fibrinolysis can maintain and aggravate bleeding from
the uterus (certain cases of menorrhagia, after conisation, after insertion of intrauterine
devices), the urinary pathways (prostatectomy, various operations on the bladder),
the digestive tract (ulcerative colitis, erosive haemorrhagic gastroduodenites), oral
cavity (tooth extractions) and the nasal mucosa. It has also been found that subarachnoid
haemorrhage is followed by increased local fibrinolysis in the cerebrospinal fluid.
It has been shown that a variety of drugs such as EACA, AMCA and PAMBA can inhibit
both normal and, in certain situations, increased fibrinolytic activity in tissues
and body fluids and thereby stop or suppress bleeding.
