Efficacy of neutrophil elastase inhibitor on type A acute aortic dissection.
BACKGROUND
Surgery for type A acute aortic dissection (AAD) is associated with a high mortality and incidence of postoperative complications, including acute respiratory failure and coagulopathy. Aim of the study was to investigate the effects of sivelestat on pulmonary function and coagulopathy in patients undergoing surgery for AAD.


METHODS
Sixty patients undergoing emergency ascending replacement for AAD were divided into two groups. Group I was administered sivelestat intravenously from the beginning of surgery until extubation. Group II was not treated with sivelestat. The platelet count, antithrombin III (AT III) level, leukocyte count, C-reactive protein (CRP) level, prothrombin time (PT), activated partial thrombin time (APTT), and prothrombin time-international normalized ratio (PT-INR) were measured.


RESULTS
The postoperative decrease of AT III and the platelet count on admission to the intensive care unit (ICU) and 3 hours later were significantly less in group I. The leukocyte count and the values of CRP, PT, APTT, and PT-INR did not differ significantly between the groups. The duration of mechanical ventilation after surgery tended to be shorter in group I.


CONCLUSIONS
Sivelestat significantly reduced the postoperative decreases in AT III and platelet count in patients undergoing emergency surgery for AAD.
Niino
T
T
Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. tenino@med.nihon-u.ac.jp
Hata
M
M
Sezai
A
A
Yoshitake
I
I
Unosawa
S
S
Fujita
K
K
Shimura
K
K
Osaka
S
S
Minami
K
K
D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000097:blood / Q000188:drug therapy* / Q000201:enzymology / Q000503:physiopathology / Q000601:surgery*; D000990:Antithrombin III / Q000378:metabolism; D001014:Aortic Aneurysm / Q000097:blood / Q000188:drug therapy* / Q000201:enzymology / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005998:Glycine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D019934:International Normalized Ratio; D007958:Leukocyte Count; D019272:Leukocyte Elastase / Q000037:antagonists & inhibitors*; D008168:Lung / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D011517:Prothrombin Time; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D015842:Serine Proteinase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D013449:Sulfonamides / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D015842:Serine Proteinase Inhibitors; D013449:Sulfonamides; D000990:Antithrombin III; D002097:C-Reactive Protein; C069195:sivelestat; D019272:Leukocyte Elastase; D005998:Glycine