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Fibrinolytic shutdown may be important in the development of postoperative deep vein thrombosis (DVT). We have previously shown that stanozolol 50 mg, given intramuscularly 24 hr before surgery, prevents the decrease in plasminogen activator activity (PA) seen on the first postoperative day in patients at high risk of DVT. To investigate the role of fibrinolytic shutdown in causation of DVT, sixty patients were randomized in a double-blind controlled trial to receive stanozolol or placebo intramuscularly, and DVT was detected by leg scanning and confirmed by venography. Scan positive DVT occurred in 11 of 31 placebo patients (35%) and 12 of 29 who received stanozolol (41%). A significant decrease in PA was confirmed in the placebo group, while stanozolol caused a significant increase in PA on the first postoperative day. Patients in either group who did not develop DVT showed minimal changes in PA. We conclude that prevention of fibrinolytic shutdown by this regimen of stanozolol does not prevent postoperative DVT, and that further studies are required to clarify the relationship of postoperative fibrinolysis and DVT.

The effects of a single pre-operative intramuscular injection of the anabolic steroid stanozolol (Stromba, 50 mg) on fibrinolysis and blood viscosity were evaluated in 14 patients at high risk of post-operative deep venous thrombosis. A control group of 13 high risk patients was also studied. The mean level of plasma plasminogen activator activity decreased significantly (p < 0.05) on the first post-operative day in the control group. In contrast, the fibrinolytic activator activity showed a non-significant rise on the first postoperative day in the stanozolol treated group. The difference in plasminogen activator levels on the first post-operative day between treated and control groups was significant (p < 0.05). Plasma plasminogen levels on the first post-operative day increased from preoperative levels in the treated group (p < 0.01), but not in the control group. The prevention of fibrinolytic shut-down and stimulation of plasminogen levels by a single pre-operative injection suggests that trials of intramuscular stanozolol in the prevention of postoperative deep venous thrombosis are indicated.