The effect of ulinastatin on hemostasis in major orthopedic surgery

Abstract

BackgroundUlinastatin, a urinary trypsin inhibitor, is widely used to treat acute systemic inflammatory disorders. However, the effects of ulinastatin, especially on the potential for hemostasis, have not been fully elucidated. This study examined whether ulinastatin had any beneficial effects on blood loss and blood transfusion requirements in patients undergoing major orthopedic surgery.MethodsEighty patients, aged 18 to 75 years, scheduled for major orthopedic surgery were enrolled in this study and were divided into the ulinastatin (n = 40) and control (n = 40) groups. Following the induction of general anesthesia, and immediately before the surgical incision, the patients in the ulinastatin group were given 5,000 units/kg of ulinastatin, which were mixed in 100 ml normal saline intravenously over 30 min, while those in the control group received the same volume of normal saline. The amounts of blood loss, infused fluid, and transfused blood products were measured throughout the study period. Blood samples for coagulation parameters were obtained before inducing anesthesia (T1), at the end of surgery (T2), and 12 h after surgery (T3).ResultsThe amounts of blood loss and infused fluid during surgery were not significantly different between the two groups. However, 12 h postoperative blood loss was significantly less in the ulinastatin group than in the control group (255.0 ± 133.2 ml VS. 395.4 ± 338.4 ml, P < 0.05).ConclusionsOur data suggest that a single infusion of ulinastatin in major orthopedic surgery is associated with decreased blood loss in the early postoperative period.

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

“…In view of the role of PMNE on coagulation and fibrinolysis [19], intraoperative administration of ulinastatin has been reported to reduce the amount of early postoperative blood loss in major orthopedic surgery [27], while we could not observe any blood conservative effect of ulinastatin in the current study. These differences might be associated with differences in the degree of PMNE activation and coagulation-fibrinolysis balances between the involved patients in both the studies.…”

Ulinastatin May Significantly Improve Postoperative Cognitive Function of Elderly Patients Undergoing Spinal Surgery by Reducing the Translocation of Lipopolysaccharide and Systemic Inflammation

“…Ulinastatin inhibits systemic inflammatory responses and reduces inflammatory factor expression and metalloproteinase activation. Concomitantly, ulinastatin can inhibit enzymatic activity and stabilize lysosomal membranes, such as matrix metalloprotease-9 (MMP-9) ( Li et al, 2018 ), trypsin, granulocytic elastase, and cathepsin ( Inoue et al, 2009 ; Lee et al, 2010 ; Fang et al, 2011 ). Through this mechanism, ulinastatin can protect intestinal barrier function.…”

“…Through this mechanism, ulinastatin can protect intestinal barrier function. In addition, ulinastatin inhibits neutrophil and monocyte activation, preventing the release of inflammatory factors ( Lee et al, 2010 ). However, whether ulinastatin can inhibit LPS and inflammatory factors triggered by non-abdominal surgery and improve cognitive function has not been elucidated.…”

Effects of Ulinastatin on Postoperative Blood Loss and Hemostasis in Atrioventricular Valve Surgery with Cardiopulmonary Bypass

“…Previously, a few studies have documented that ulinastatin reduced postoperative blood loss in major orthopedic surgery and showed a non-significant trend towards decreased blood loss in gastrectomy [13]. The extent of the systemic inflammatory reaction actually varies according to the type of surgery and the use of CPB.…”