Antifibrinolytic therapy in cardiac surgery

Area of Science:

• Cardiothoracic Surgery
• Anesthesiology
• Pharmacology

Background:

• Excessive bleeding is a significant complication in repeat and complex cardiac surgeries.
• Aprotinin, an antifibrinolytic agent, is FDA-approved but raises concerns regarding cost and side effects.
• Alternative antifibrinolytic therapies are sought to manage bleeding effectively and safely.

Purpose of the Study:

• To review the current status of antifibrinolytic therapy in cardiothoracic surgery.
• To propose epsilon-aminocaproic acid as a safe, inexpensive, and effective alternative to aprotinin.
• To suggest a specific dosing protocol for epsilon-aminocaproic acid in cardiac surgery.

Main Methods:

• Review of current antifibrinolytic therapies for excessive bleeding in cardiothoracic surgery.
• Evaluation of epsilon-aminocaproic acid as a potential alternative to aprotinin.
• Proposal of a single intravenous dose of 10 g epsilon-aminocaproic acid before cardiopulmonary bypass.

Main Results:

• Epsilon-aminocaproic acid is presented as a safe, inexpensive, and effective antifibrinolytic agent.
• The proposed protocol involves a single intravenous dose of 10 g administered immediately before cardiopulmonary bypass.
• This approach offers a viable alternative to aprotinin for managing bleeding complications.

Conclusions:

• A single intravenous dose of epsilon-aminocaproic acid is a recommended antifibrinolytic strategy.
• This protocol provides a safe, cost-effective, and efficacious alternative to aprotinin in cardiac surgery.
• Further clinical and laboratory research is warranted to validate and refine this therapeutic approach.