Effects of a protease inhibitor, ulinastatin, on coagulation and fibrinolysis in abdominal surgery.
OBJECTIVE
Ulinastatin is well known to inhibit the activity of polymorphonuclear leukocyte elastase (PMNE). The PMNE concentration correlates with the activities of coagulation and fibrinolysis. The purpose of the present study was to investigate the effects of ulinastatin, a protease inhibitor, on coagulation and fibrinolysis in abdominal surgery.


METHODS
Thirty patients, aged 40 to 70 years, with American Society of Anesthesiologists (ASA) physical status I or II, scheduled for major abdominal surgery, were enrolled. Anesthesia was induced with midazolam and thiopental, and was maintained with sevoflurane, nitrous oxide in oxygen, and an epidural block. An infusion of ulinastatin, 6000 units x kg(-1) in 30 min, was started 1 h after the start of surgery in the ulinastatin group (15 patients). In the control group (15 patients), no protease inhibitors were infused. White blood cell count; platelet count; prothrombin time; activated partial thromboplastin time; and plasma concentrations of PMNE, antithrombin (AT), fibrin/fibrinogen degradation product (FDP), fibrinogen, plasminogen, plasmin-(alpha2) plasmin inhibitor complex (PIC), and thrombin-antithrombin complex (TAT) were measured before, at the end of, and 12 h after surgery.


RESULTS
TAT, PIC, and FDP after surgery were significantly lower in the ulinastatin group than in the control group. AT was decreased in the control group but not in the ulinastatin group, with significant differences between the two groups.


CONCLUSIONS
Ulinastatin could inhibit coagulation and fibrinolysis in abdominal surgery.
Nishiyama
Tomoki
T
Department of Anesthesiology, The University of Tokyo, Tokyo, Japan.
Yokoyama
Takeshi
T
Yamashita
Koichi
K
D000005:Abdomen / Q000601:surgery*; D000990:Antithrombin III / Q000187:drug effects; D000991:Antithrombins / Q000187:drug effects; D001777:Blood Coagulation / Q000187:drug effects*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000187:drug effects; D005340:Fibrinogen / Q000187:drug effects; D005341:Fibrinolysin / Q000187:drug effects; D005342:Fibrinolysis / Q000187:drug effects*; D006023:Glycoproteins / Q000494:pharmacology*; D006801:Humans; D007958:Leukocyte Count / Q000706:statistics & numerical data; D019272:Leukocyte Elastase / Q000097:blood / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time / Q000706:statistics & numerical data; D010447:Peptide Hydrolases / Q000097:blood / Q000187:drug effects; D010958:Plasminogen / Q000187:drug effects; D010976:Platelet Count / Q000706:statistics & numerical data; D011480:Protease Inhibitors / Q000494:pharmacology*; D011517:Prothrombin Time / Q000706:statistics & numerical data; D013599:Systole; D014361:Trypsin Inhibitors / Q000494:pharmacology*; D000979:alpha-2-Antiplasmin / Q000187:drug effects
D000991:Antithrombins; D005338:Fibrin Fibrinogen Degradation Products; D006023:Glycoproteins; D011480:Protease Inhibitors; D014361:Trypsin Inhibitors; D000979:alpha-2-Antiplasmin; C046193:antithrombin III-protease complex; C037742:plasmin-plasmin inhibitor complex; D000990:Antithrombin III; D005340:Fibrinogen; D010958:Plasminogen; D010447:Peptide Hydrolases; D019272:Leukocyte Elastase; D005341:Fibrinolysin; C028665:urinastatin