Current antifibrinolytic therapy for coronary artery revascularization

Area of Science:

• Cardiology
• Pharmacology
• Surgical Science

Background:

• Antifibrinolytic therapy is widely used in over 700,000 cardiac surgeries annually, particularly for coronary artery bypass graft (CABG) procedures.
• Commonly employed antifibrinolytics include synthetic lysine analogues and serine protease inhibitors, both effective in reducing blood transfusion rates.
• Emerging data suggest potential adverse outcomes associated with serine protease inhibitors used in CABG.

Purpose of the Study:

• To review the clinical significance of antifibrinolytic therapy in cardiac surgery.
• To discuss the current implications and emerging concerns regarding the use of different antifibrinolytic agents, specifically serine protease inhibitors.

Main Methods:

• This review synthesizes current literature on antifibrinolytic therapy in coronary artery revascularization.
• Analysis focuses on the efficacy, safety, and clinical outcomes associated with synthetic lysine analogues and serine protease inhibitors.

Main Results:

• Both classes of antifibrinolytics demonstrate efficacy in decreasing the need for blood transfusions during CABG.
• Recent findings indicate a potential association between serine protease inhibitors and an increased incidence of adverse events.

Conclusions:

• Antifibrinolytic therapy remains crucial in CABG surgery for managing blood loss and transfusion requirements.
• The potential risks associated with serine protease inhibitors necessitate careful consideration and further investigation into their role and alternatives.