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Antifibrinolytics in Cardiac Surgery: What Is the Best Practice in 2022?

  • Blood Management (KA Tanaka, Section Editor)
  • Published:
Current Anesthesiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review describes the latest information related to the administration of lysine analogues during cardiac surgery. An awareness of appropriate antifibrinolytic administration will maximize benefit for blood conservation efforts and possibly decrease morbidity and mortality.

Recent Findings

Recent pharmacodynamic assessments for antifibrinolytics are more sensitive. Research suggests that lower dose regimens may not provide maximal inhibition of fibrinolysis but may be equally effective in decreasing transfusion of blood products. Effective lower dose regimens may decrease the incidence of seizures and possibly morbidity and mortality.

Summary

The lysine analogues are a key addition to blood conservation efforts in cardiac surgery. Finding an optimized dosing regimen is complex and may include factors such as total dosage and timing of administration. Understanding of the pharmacokinetics and pharmacodynamics of these drugs will help perioperative physicians evaluate their own practice and improve their own regimens.

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Authors and Affiliations

  1. Division of Cardiovascular Anesthesia, Department of Anesthesiology, University of Maryland School of Medicine, 22 S. Greene St, Baltimore, MD, 21201, USA

    Erik R. Strauss, Richard Booth & Susan Sankova

  2. Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA

    Monica Taneja & Megan G. Anders

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  1. Erik R. Strauss
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Correspondence to Erik R. Strauss.

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Erik Strauss, Monica Taneja, Richard Booth, Susan Sankova, and Megan Anders declare they have no conflict of interest related to this article.

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Search Strategy

The information contained in the review portions of this article is found in the published literature related to antifibrinolytics for cardiac surgery. The Database Resources of the National Center for Biotechnology Information (NCBI) was searched with the phrase “antifibrinolytics in cardiac surgery” to generate a list of publications. This list was screened and updated, and pertinent articles were used in drafting this manuscript.

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Strauss, E.R., Taneja, M., Booth, R. et al. Antifibrinolytics in Cardiac Surgery: What Is the Best Practice in 2022?. Curr Anesthesiol Rep 12, 501–507 (2022). https://doi.org/10.1007/s40140-022-00538-w

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