Korean J Anesthesiol.  2013 Feb;64(2):105-111. 10.4097/kjae.2013.64.2.105.

Effects of ulinastatin on coagulation in high-risk patients undergoing off-pump coronary artery bypass graft surgery

• Kim NY
• Shim JK
• Bang SO
• Sim JS
• Song JW
• Kwak YL

• KMID: 1798221
• DOI: http://doi.org/10.4097/kjae.2013.64.2.105

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.

Keyword

Coagulability; hsCRP; OPCAB; Ulinastatin

MeSH Terms

Antithrombin III
Blood Platelets
C-Reactive Protein
Coronary Artery Bypass, Off-Pump
Cytokines
Glycoproteins
Humans
Leukocyte Elastase
Peptide Hydrolases
Prothrombin
Reference Values
Thrombophilia
Transplants
Antithrombin III
C-Reactive Protein
Cytokines
Glycoproteins
Leukocyte Elastase
Peptide Hydrolases
Prothrombin