What are antifibrinolytics and when are they used as an alternative to transfusion?

Updated: Apr 16, 2019
  • Author: Linda L Maerz, MD, FACS, FCCM; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Answer

Pharmacologic antifibrinolytics, such as aprotinin, epsilon aminocaproic acid (EACA), and TXA can reduce perioperative blood loss by retarding or arresting fibrinolysis.  The role of TXA in the adjunctive management of severe acute traumatic hemorrhage is discussed above.  Aprotinin has been documented to decrease blood loss in certain cardiac, orthopedic, and transplant surgeries by inhibiting serine proteases, such as plasmin. EACA has been successfully used to reduce hemorrhage volume during cardiac surgery, portocaval shunting, aplastic anemia-related hemorrhage, abruptio placentae, cirrhosis-associated GI bleeding, and neoplasm-related hemorrhage (particularly prostate, lung, stomach, and cervix); all of these clinical entities are linked by the underlying theme of fibrinolysis-associated red cell mass loss. EACA primarily inhibits plasminogen activators but also demonstrates antiplasmin activity.

Aprotinin is now only available via a limited-access protocol. Fergusson, et al. reported an increased risk for death compared with TXA or EACA in high-risk cardiac surgery. [72]


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