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

Area of Science:

• Cardiovascular Surgery
• Coagulation Disorders
• Inflammation Research

Background:

• Off-pump coronary artery bypass grafting (OPCAB) can trigger systemic inflammation and myocardial ischemia/reperfusion injury, leading to hypercoagulability.
• Elevated high-sensitivity C-reactive protein (hsCRP) indicates increased risk and inflammation in patients undergoing OPCAB.
• Ulinastatin, an inhibitor of polymorphonuclear leukocyte elastase and pro-inflammatory cytokines, was investigated for its potential to mitigate these effects.

Purpose of the Study:

• To evaluate the effect of ulinastatin on coagulation status in patients with elevated hsCRP undergoing OPCAB.
• To determine if ulinastatin can reduce hypercoagulability and blood loss in this specific patient population.

Main Methods:

• A randomized controlled trial involving 50 patients with preoperative hsCRP > 3.0 mg/L undergoing OPCAB.
• Patients were allocated to receive either ulinastatin (600,000 U) or a control (no ulinastatin).
• Serum markers of coagulation (thrombin-antithrombin complex [TAT], prothrombin fragment 1+2 [F1+2]) and platelet factor-4 (PF-4) were measured preoperatively, immediately post-surgery, and 24 hours post-surgery. Blood loss and transfusion requirements were also assessed.

Main Results:

• Baseline levels of TAT, F1+2, and PF-4 were elevated in all patients, indicating pre-existing hypercoagulability.
• F1+2 levels increased post-surgery in both groups, with no significant difference between ulinastatin and control groups.
• No significant differences were observed between the groups regarding other coagulation parameters, blood loss, or transfusion requirements.

Conclusions:

• Intraoperative administration of ulinastatin did not provide a significant benefit in managing coagulation or reducing blood loss in high-risk patients with elevated hsCRP undergoing multivessel OPCAB.
• Patients undergoing multivessel OPCAB with elevated hsCRP exhibit pre-existing hypercoagulability, which was not favorably influenced by ulinastatin treatment.