Journal of Anesthesia

, Volume 20, Issue 3, pp 179–182

Effects of a protease inhibitor, ulinastatin, on coagulation and fibrinolysis in abdominal surgery

Authors

  • Tomoki Nishiyama
    • Department of AnesthesiologyThe University of Tokyo
  • Takeshi Yokoyama
    • Department of Anesthesiology and Critical Care MedicineKochi University Medical School
  • Koichi Yamashita
    • Department of Anesthesiology and Critical Care MedicineKochi University Medical School
Article

DOI: 10.1007/s00540-006-0396-7

Cite this article as:
Nishiyama, T., Yokoyama, T. & Yamashita, K. J Anesth (2006) 20: 179. doi:10.1007/s00540-006-0396-7

Abstract

Purpose

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·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-α2 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.

Conclusion

Ulinastatin could inhibit coagulation and fibrinolysis in abdominal surgery.

Key words

Polymorphonuclear leukocyte elastaseProtease inhibitorUlinastatinCoagulationFibrinolysis

Copyright information

© JSA 2006