Ulinastatin reduces postoperative bleeding and red blood cell transfusion in patients undergoing cardiac surgery: A PRISMA-compliant systematic review and meta-analysis

• Published in: Medicine (Baltimore) 2020-02, Vol.99 (7), p.e19184-e19184
• Main Authors: Yao, Yun-Tai, Fang, Neng-Xin, Liu, Ding-Hua, Li, Li-Huan
• Format: Article
• Language: English
• Subjects: Blood Coagulation - drug effects; Blood Platelets - drug effects; Blood Transfusion - statistics & numerical data; Cardiac Surgical Procedures; Glycoproteins - pharmacology; Glycoproteins - therapeutic use; Humans; Postoperative Hemorrhage - prevention & control; Systematic Review and Meta-Analysis; Trypsin Inhibitors - pharmacology; Trypsin Inhibitors - therapeutic use
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000019184

Ulinastatin is a type of glycoprotein and a nonspecific wide-spectrum protease inhibitor like antifibrinolytic agent aprotinin. Whether Ulinastatin has similar beneficial effects on blood conservation in cardiac surgical patients as aprotinin remains undetermined. Therefore, a systematic review and meta-analysis were performed to evaluate the effects of Ulinastatin on perioperative bleeding and transfusion in patients who underwent cardiac surgery. Electronic databases were searched to identify all clinical trials comparing Ulinastatin with placebo/blank on postoperative bleeding and transfusion in patients undergoing cardiac surgery. Primary outcomes included perioperative blood loss, blood transfusion, postoperative re-exploration for bleeding. Secondary outcomes include perioperative hemoglobin level, platelet counts and functions, coagulation tests, inflammatory cytokines level, and so on. For continuous variables, treatment effects were calculated as weighted mean difference (WMD) and 95% confidential interval (CI). For dichotomous data, treatment effects were calculated as odds ratio and 95% CI. Statistical significance was defined as P  .05). Ulinastatin reduces postoperative bleeding (WMD = -0.73, 95% CI: -1.17 to -0.28, P = .001) and red blood cell (RBC) transfusion (WMD = -0.70, 95% CI: -1.26 to -0.14, P = .01), inhibits hyperfibrinolysis as manifested by lower level of postoperative D-dimer (WMD = -0.87, 95% CI: -1.34 to -0.39, P = .0003). This meta-analysis has found some evidence showing that Ulinastatin reduces postoperative bleeding and RBC transfusion in patients undergoing cardiac surgery. However, these findings should be interpreted rigorously. Further well-conducted trials are required to assess the blood-saving effects and mechanisms of Ulinastatin.