Journal of Anesthesia

, Volume 24, Issue 1, pp 96–106

Lessons from the aprotinin saga: current perspective on antifibrinolytic therapy in cardiac surgery

  • Masahiro Ide
  • Daniel Bolliger
  • Taro Taketomi
  • Kenichi A. Tanaka
Review Article

DOI: 10.1007/s00540-009-0866-9

Cite this article as:
Ide, M., Bolliger, D., Taketomi, T. et al. J Anesth (2010) 24: 96. doi:10.1007/s00540-009-0866-9
  • 245 Views

Abstract

Antifibrinolytic agents have been prophylactically administered to patients undergoing cardiopulmonary bypass (CPB) to reduce postoperative bleeding due to plasmin-mediated coagulation disturbances. After the recent market withdrawal of aprotinin, a potent bovine-derived plasmin inhibitor, two lysine analogs, ε-aminocaproic acid and tranexamic acid are currently available for clinical use. Although the use of aprotinin recently raised major concerns about postoperative thrombosis and organ dysfunctions, there is a paucity of information on the potential complications related to lysine analogs. Using the available preclinical and clinical data, we present current perspectives on the hemostatic mechanism and potential harms of antifbirnolytic therapy related to cardiac surgery. Fibrin formation is the critical step for hemostasis at the site of vascular injury, and localized fibrinolytic activity counterbalances excess fibrin formation which might result in vascular occlusion. Inhibition of the endogenous fibrinolytic system may be associated with thrombotic complications in susceptible organs. It is thus important to understand CPB-related changes in endogenous fibrinolytic proteins (e.g., tissue plasminogen activator (tPA), plasminogen) and antifibrinolytic proteins (e.g., α2-antiplasmin).

Keywords

Antifibrinolytic therapyComplicationsAprotininε-Aminocaproic acidTranexamic acid

Copyright information

© Japanese Society of Anesthesiologists 2009

Authors and Affiliations

  • Masahiro Ide
    • 1
  • Daniel Bolliger
    • 2
  • Taro Taketomi
    • 2
  • Kenichi A. Tanaka
    • 2
  1. 1.Kobe Anesthesia AssociatesHyogoJapan
  2. 2.Department of AnesthesiologyEmory University School of MedicineAtlantaUSA