Lessons learned in antifibrinolytic therapy: The BART trial

Despite nearly 2 decades of published reports and clinical trials demonstrating the relative safety and efficacy of aprotinin in adult cardiac surgical patients at increased risk of bleeding-culminating in an official endorsement of the usage of aprotinin in such patients from both cardiac surgery and anesthesiology subspecialty committees-several more recent studies have raised profound concerns regarding the safety of aprotinin in these same patients. These studies and the implications thereof have ultimately resulted in the withdrawal of aprotinin from clinical usage internationally. This article will briefly review these developments with the hope of understanding how this abrupt turnabout took place and will attempt to understand how such events can be avoided in the future.