title: Review of the fibrinolytic system: comparison of different antifibrinolytics used during cardiopulmonary bypass.
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.
authors.affiliation: Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Caroline
authors.initials: C
authors.lastname: Van Aelbrouck
authors.forename: Lars
authors.initials: L
authors.lastname: Englberger
authors.forename: David
authors.initials: D
authors.lastname: Faraoni
mesh_terms: D000933:Antifibrinolytic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D005342:Fibrinolysis / Q000187:drug effects*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment
chemical_list: D000933:Antifibrinolytic Agents