Effect of Neutrophil Elastase Inhibitor on Coagulability in Patients after Radical Esophagectomy

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  • Takemura Masashi
    Department of Gastroenterological Surgery, Osaka City General Hospital
  • Higashino Masayuki
    Department of Gastroenterological Surgery, Osaka City General Hospital
  • Osugi Harushi
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine
  • Lee Shigeru
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine
  • Kishida Satoru
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine
  • Fukuhara Kenichiro
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine
  • Nishizawa Satoshi
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine
  • Iwasaki Hiroshi
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine
  • Gyobu Ken
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine
  • Yoshida Kayo
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine

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Other Title
  • 食道癌術後凝固機能におよぼす好中球エラスターゼ阻害剤の影響
  • ショクドウ ガン ジュツゴ ギョウコ キノウ ニ オヨボス コウチュウキュウ エラスターゼ ソガイザイ ノ エイキョウ

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It is known that a hypercoagulable state develops after radical esophagectomy for cancer. To prevent hypercoagulability, anti-inflammatory agents, such as steroids, are administrated. We studied the effect of neutrophil elastase inhibitor (Sivelestat sodium hydrate, SN) on coagulability in patients after radical esophagectomy. A total of 41 patients who had undergone radical esophagectomy together with reconstruction were stratified into two groups. In the SN+group (n=21), SN was administrated continuously, at 0.2mg/kg/hr, from just after surgery until the 5th post-operative day. In the other group no administration took place. All patients received an injection of methylpredonisolone of 500 mg/body just before surgery. The platelet count, level of fibrinogen (FBG), FDP, D-Dimer, AT3, TAT, activated partial thrombin time (APTT), protein C and alfa-2 plasmin inhibitor (A2PI) were measured before surgery and on the 1st to 7th days after operation. Differences in platelet count, and in levels of FBG, FDP, D-Dimer and TAT were not significant between the two groups. In the SN+group, the level of AT3 and protein C were higher than the SN- group on the 2nd and 3rd post-operative days, and α2PI on the 3rd post-operative day. In the SN- group, the level of APTT was higher on the 3rd postoperative day. In conclusion, continuous infusion of SN is effective to prevent hypercoagulability after radical esophagectomy.

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