title: Effects of ulinastatin on coagulation in high-risk patients undergoing off-pump coronary artery bypass graft surgery.
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.
authors: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Na-Young
authors: NY
authors: Kim
authors: Jae-Kwang
authors: JK
authors: Shim
authors: Seo-Ouk
authors: SO
authors: Bang
authors: Jee-Suk
authors: JS
authors: Sim
authors: Jong-Wook
authors: JW
authors: Song
authors: Young-Lan
authors: YL
authors: Kwak
keywords: Coagulability; OPCAB; Ulinastatin; hsCRP