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Catheter-based Endovascular Angioplasty for Fibrosing Mediastinitis-associated Pulmonary Vein Stenosis

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Antifibrinolytics in cardiac surgery.

Achal Dhir¹

¹Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, Ontario, Canada.

Annals of Cardiac Anaesthesia

|April 3, 2013

Summary

Cardiac surgery increases bleeding risk, with antifibrinolytics like tranexamic acid (TA) and epsilon amino caproic acid (EACA) used to manage hyper-fibrinolysis. Careful selection is crucial due to varying efficacy and side effects.

Area of Science:

Cardiovascular Surgery
Anesthesiology
Pharmacology

Background:

Cardiac surgery significantly strains blood bank resources.
Excessive bleeding during cardiac surgery increases morbidity and mortality.
Hyper-fibrinolysis is a key contributor to increased bleeding in cardiac procedures.

Purpose of the Study:

To review the role and comparative efficacy of antifibrinolytic agents in cardiac surgery.
To discuss the risk-benefit profiles of available antifibrinolytic options post-aprotinin withdrawal.
To guide the selection of appropriate antifibrinolytic agents based on patient-specific factors.

Main Methods:

Review of antifibrinolytic agents used in cardiac surgery.
Comparison of efficacy and side effects of aprotinin, tranexamic acid (TA), and epsilon amino caproic acid (EACA).

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Analysis of the impact of antifibrinolytics on blood loss, transfusion rates, and patient outcomes.

Main Results:

Aprotinin demonstrated the strongest reduction in blood loss and transfusion needs but carried significant side effects and mortality concerns.
Tranexamic acid (TA) offers intermediate efficacy with increased seizure risk.
Epsilon amino caproic acid (EACA) is least effective but associated with fewer side effects.

Conclusions:

Antifibrinolytic agents are essential for managing bleeding in cardiac surgery but act as double-edged swords.
The choice between TA and EACA requires careful consideration of their distinct risk-benefit profiles.
Personalized selection of antifibrinolytics is paramount to optimize outcomes and minimize thrombotic risks.