How is Transamin used for patients undergoing cardiac surgery with cardiopulmonary bypass?

Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at high risk for postoperative bleeding. Excessive bleeding after CPB is attributable not only to the size of surgical wound required for the operation but also the activation of both coagulation and fibrinolysis by the passage of blood through the CPB bypass. The stimulation of the formation and dissolution of blood clots causes excessive consumption of coagulant factors and predisposes patients to prolonged and excessive bleeding. The severe bleeding complication increases morbidity and mortality and also the need for transfusion, reoperation and costs.

Nakashima et al. evaluated the effect of Transamin on blood loss after CPB in 157 patients who underwent elective valve replacement operations. Transamin was administered in 90 patients (Group TA) at 50 mg/kg just before and after CPB, and every minute during CPB. Remaining 67 patients serve as the control group (Group N). The time required for hemostasis was significantly shorter in Group TA (6.7 + 1.5 hr vs. 6.0 + 1.5 hr, p – 0.006). The amount of chest tube drainage within 12 hr after surgery was significantly reduced and the chest tube could be removed earlier in Grout TA. The total blood loss was significantly smaller than in Group TA (402 + 292 ml) than in Group N (631 + 609 ml, p = 0.003). It was concluded that antifibrinolytic therapy during CPB with Transamin reduces postoperative loss, and shortens the operation time due to an improvement in hemostasis.

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