High-dose ulinastatin reduces postoperative bleeding and provides platelet-protective effects in patients undergoing heart valve replacement surgery.

BACKGROUND: The aim of this prospective study was to investigate the effect of a high dose of ulinastatin on platelets and coagulation in patients undergoing mitral valve and/or aortic valve replacement with cardiopulmonary bypass (CPB). MATERIALS AND METHODS: 273 patients were enrolled in this open-label study. According to patients' willingness, 243 patients were assigned to the ulinastatin group and 30 to the control group. In the ulinastatin group, ulinastatin (300,000 U) was given after the induction of anesthesia, ulinastatin (400,000 U) was added to the CPB pump prime, and then ulinastatin (300,000 U) was administered after weaning from CPB. Complete blood count and coagulation function test were conducted 1 day before surgery and on the first postoperative day. Bleeding and other safety events were recorded during hospitalization. RESULTS: Less postoperative major bleeding occurred in the ulinastatin group (0.4 vs. 6.7%, p = 0.03). Moreover, 1 day after CPB, platelet count in the ulinastatin group increased significantly compared to that in the control group (157.7 ± 71.0 vs. 132.1 ± 59.6, p = 0.03). Interestingly and contrary to what was expected, activated partial thromboplastin time (APTT) and prothrombin time (PT) did not differ significantly between the two groups. Ulinastatin application did not cause significant increase in total costs (p = 0.89). CONCLUSION: In heart valve replacement surgery with CPB, high-dose ulinastatin could reduce postoperative bleeding and promote platelet recovery with no significant additional medical cost.

The Impact of a Simplified Scoring System on Long-Term Survival Outcomes in Patients with Gastric Cancer Undergoing Gastrectomy.

Gastric cancer (GC) is a worldwide public health concern. We aimed to investigate the association between preoperative prognostic scoring system based on the combination of age, American Society of Anesthesiologists physical status (ASA-PS), and prognostic nutritional index (PNI) and long-term survival outcomes in patients with (GC). Data from 513 patients were analyzed using Cox proportional hazards regression models to evaluate the association between this prognostic score system and risks of all-cause mortality. This simple prognostic score system (0-3 points) was an independent predictor of long-term survival outcomes in patients with GC after radical gastrectomy based on multivariate analyses. Prognostic 1-point score, 2-point score, and 3-point score significantly increased 50% (95% CI, 14%-98%; P = 0.004), 75% (95% CI, 22%-151%; P = 0.003), and 116% (95% CI, 26%-271%; P = 0.005) hazards of 5-year all-cause mortality, respectively, compared to prognostic 0-point score. Five-year overall survival rates were significantly decreased as prognostic scores increased, (0 point, 57.3%; 1-point, 41.3%; 2-ponint, 36.6%; 3-point, 25.9%; P < 0.01; area under the curve [AUC] = 0.62). A prognostic scoring method based on combination of age, ASA-PS, and PNI may serve as an independent risk stratification metric for long-term survival in patients with GC.