[Effects of ulinastatin on coagulation and platelet function in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass].

Objective: To investigate the effects of ulinastatin (U) on coagulation, platelet function, and postoperative bleeding in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).

Methods: Thirty-six selective patients undergoing CABG with CPB were randomly assigned to two groups: Group U (n=18) in which ulinastatin 4 x 10(6) U in 100 ml normal saline (NS) was infused intravenously for 30 min since skin incision with 4 x 10(6) U added to the CPB pump prime, and then 2 x 10(6) U of ulinastatin was infused intravenously at a rate of 4-6 x 10(4) U x h(-1) until the chest was closed; and control group (Group C, n=18) in which 100 ml NS was infused without ulinastatin. Peripheral blood samples were collected 1 min before operation (T0), 1 min before heparinization (T1), at the end of operation (T2), 6 hour after operation (T3), and 24 hour after operation (T4). Platelet membrane glucoprotein IIb/IIIa (GP IIb/IIIa) and platelet alpha granule membrane protein-140 (CD62p) were measured by flow cytometry. Activated partial thromboplasin time (APTT), activated coagulation time of whole blood (ACT), prothrombin time (PT), fibrinogen, and platelet number were also measured. Postoperative blood loss and allogeneic transfusion were recorded.

Results: There were no statistical differences in CD26p, GP IIb/IIIa, and PT between the 2 groups (all P > 0.05). The APTT levels was significantly shortened in Group U at T1, T3 and T4 compared to T0. The APTT levels of Group U from T1 to T4 were all significantly lower than those of Group C (all P < 0.05). The ACT levels after heparinization and during CPB in Group U were significantly shorter than those of Group C (all P < 0.01), and the amount of added heparin during CPB of Group U was significantly higher than that of Group C (P < 0.01). There were not significant differences in platelet amount, fibrinogen, total amount of blood loss in 24 h after operation was 960 (420, 1500) ml in group C, and 850 (380, 1600) ml in group U (P > 0.05). The platelet count, CD26p, GPIIb/IIIa, total amounts of blood loss and blood infusion 24 h after operation, and hemoglobin concentration between these 2 groups (all P > 0.05).

Conclusion: Ulinastatin shortens the APTT and ACT after heparinization, increases the dose of heparin during CPB, has no effect on the expression of GP IIb-IIIa and CD62p, and does not reduce postoperative blood loss.