Title:Review of the Fibrinolytic System: Comparison of Different Antifibrinolytics used During Cardiopulmonary Bypass
Volume: 7
Issue: 3
Author(s): Caroline Van Aelbrouck, Lars Englberger and David Faraoni
Affiliation:
Keywords:
Antifibrinolytics, aprotinin, epsilon-aminocaproic acid, fibrinolysis, tranexamic acid
Abstract: Antifibrinolytic agents are often used in different clinical situations, especially in cardiac surgery. During several
years, aprotinin was the drug of choice because more than antifibrinolytic properties, aprotinin offers a direct effect
on kallikrein and inflammatory pathways. In 2008, The Blood Conservation Using Antifibrinolytics in a Randomized
Trial (BART) initiated a discussion about real risks associated with aprotinin administration. Tranexamic acid and epsilon-
aminocaproic acid appear to be interesting alternatives in our daily practice. The exact mechanism of action, the
pharmacokinetic parameters, the efficacy, and the safety profile need to be clarified for lysine analogs. In this review, the
different antifibrinolytics will be described with a special interest into the route of work, and recent patents. Current
studies about the pharmacokinetic and the pharmacodynamic profile will be described, and finally the benefit-to-risk
balance in patients undergoing cardiac surgery with cardiopulmonary bypass will be discussed.
