Effects of ulinastatin on coagulation in high-risk patients undergoing off-pump coronary artery bypass graft surgery.
10.4097/kjae.2013.64.2.105
- Author:
Na Young KIM
1
;
Jae Kwang SHIM
;
Seo Ouk BANG
;
Jee Suk SIM
;
Jong Wook SONG
;
Young Lan KWAK
Author Information
1. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. sjw72331@yahoo.co.kr
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
Coagulability;
hsCRP;
OPCAB;
Ulinastatin
- MeSH:
Antithrombin III;
Blood Platelets;
C-Reactive Protein;
Coronary Artery Bypass, Off-Pump;
Cytokines;
Glycoproteins;
Humans;
Leukocyte Elastase;
Peptide Hydrolases;
Prothrombin;
Reference Values;
Thrombophilia;
Transplants
- From:Korean Journal of Anesthesiology
2013;64(2):105-111
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Both systemic inflammatory reaction and regional myocardial ischemia/reperfusion injury may elicit hypercoagulability after off-pump coronary artery bypass grafting (OPCAB). We investigated the influence of ulinastatin, which suppresses the activity of polymorphonuclear leukocyte elastase and production of pro-inflammatory cytokines, on coagulation in patients with elevated high-sensitivity C-reactive protein (hsCRP) undergoing OPCAB. METHODS: Fifty patients whose preoperative hsCRP > 3.0 mg/L were randomly allocated into the ulinastatin (600,000 U) or control group. Serum concentrations of thrombin-antithrombin complex (TAT) and prothrombin fragment 1+2 (F1+2) were measured preoperatively, immediately after surgery, and at 24 h after surgery, respectively. Secondary endpoints included platelet factor (PF)-4, amount of blood loss, and transfusion requirement. RESULTS: All baseline values of TAT, F1+2, and PF-4 were higher than the normal range in both groups. F1+2 was elevated in both groups at immediate, and at 24 h after surgery as compared to baseline value, without any significant intergroup differences. Remaining coagulation parameters, transfusion requirement and blood loss during operation and postoperative 24 h were not different between the two groups. CONCLUSIONS: Intraoperative administration of ulinastatin did not convey beneficial influence in terms of coagulation and blood loss in high-risk patients with elevated hsCRP undergoing multivessel OPCAB, who already exhibited hypercoagulability before surgery.
