Canadian Journal of Anesthesia, Vol 41, 1104-1112, Copyright © 1994 by Canadian Anesthesiologists' Society

ARTICLES

Natural and synthetic antifibrinolytics in adult cardiac surgery: efficacy, effectiveness and efficiency

JF Hardy and S Belisle
Department of Anesthesia, Montreal Heart Institute, Quebec, Canada.

Epsilon-aminocaproic acid and tranexamic acid, two synthetic antifibrinolytics, and aprotinin, an antifibrinolytic derived from bovine lung, are used to reduce excessive bleeding and transfusion of homologous blood products (HBP) after cardiac surgery. This review analyzes the studies on the utilization of antifibrinolytics in adult cardiac surgery according to the epidemiological concepts of efficacy, effectiveness and efficiency. A majority of published studies confirm the efficacy of antifibrinolytics administered prophylactically to reduce postoperative bleeding and transfusion of HBP. More studies are needed, however, to compare antifibrinolytics and determine if any one is superior to the others. Despite their demonstrated efficacy, antifibrinolytics are only one of the options available to diminish the use of HBP. Other blood-saving techniques, surgical expertise, temperature during cardiopulmonary bypass and respect of established transfusion guidelines may modify the effectiveness of antifibrinolytics to the point where antifibrinolytics may not be necessary. At this time, insufficient data have been published to perform a cost vs benefit analysis of the use of antifibrinolytics. This complex analysis takes into account not only direct costs (cost of the drug and of blood products), but also the ensuing effects of treatment such as: length of stay in the operating room, in the intensive care unit and in the hospital; need for surgical re-exploration; treatment of transfusion or drug-related complications, etc. In particular, the risk of thrombotic complications associated with antifibrinolytics is the subject of an ongoing, unresolved controversy.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				S. Dial, E. Delabays, M. Albert, A. Gonzalez, J. Camarda, A. Law, and D. Menzies Hemodilution and surgical hemostasis contribute significantly to transfusion requirements in patients undergoing coronary artery bypass J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 654 - 654. [Abstract] [Full Text] [PDF]

				Y. Deng, K. Byth, and H. S Paterson Age and Left Ventricular Impairment Predict Reopening for Bleeding Asian Cardiovasc Thorac Ann, June 1, 2003; 11(2): 147 - 152. [Abstract] [Full Text] [PDF]

				E. K. Heres, J. C. Horrow, G. P. Gravlee, B. E. Tardiff, J. Luber Jr, J. Schneider, T. Barragry, and R. Broughton A Dose-Determining Trial of Heparinase-I (NeutralaseTM) for Heparin Neutralization in Coronary Artery Surgery Anesth. Analg., December 1, 2001; 93(6): 1446 - 1452. [Abstract] [Full Text] [PDF]

				S. Chauhan, B. A. Kumar, B. H. Rao, M. S. Rao, B. Dubey, N. Saxena, and P. Venugopal Efficacy of aprotinin, epsilon aminocaproic acid, or combination in cyanotic heart disease Ann. Thorac. Surg., October 1, 2000; 70(4): 1308 - 1312. [Abstract] [Full Text] [PDF]

				A. Dalmau, A. Sabate, F. Acosta, L. Garcia-Huete, M. Koo, T. Sansano, A. Rafecas, J. Figueras, E. Jaurrieta, and P. Parrilla Tranexamic Acid Reduces Red Cell Transfusion Better than {epsilon}-Aminocaproic Acid or Placebo in Liver Transplantation Anesth. Analg., July 1, 2000; 91(1): 29 - 34. [Abstract] [Full Text] [PDF]

				C. C. D'Errico Pharmacoeconomics Analysis in a Pediatric Population Ann. Thorac. Surg., June 1, 1998; 65(90060): S52 - 55. [Abstract] [Full Text] [PDF]

				L. J. Dacey, J. J. Munoz, Y. R. Baribeau, E. R. Johnson, S. J. Lahey, B. J. Leavitt, R. D. Quinn, W. C. Nugent, J. D. Birkmeyer, G. T. O'Connor, et al. Reexploration for Hemorrhage Following Coronary Artery Bypass Grafting: Incidence and Risk Factors Arch Surg, April 1, 1998; 133(4): 442 - 447. [Abstract] [Full Text] [PDF]

				B. Eberle, E. Mayer, G. Hafner, J. Heinermann, M. Dahm, W. Prellwitz, W. Dick, and H. Oelert High-Dose {epsilon}-Aminocaproic Acid Versus Aprotinin: Antifibrinolytic Efficacy in First-Time Coronary Operations Ann. Thorac. Surg., March 1, 1998; 65(3): 667 - 673. [Abstract] [Full Text] [PDF]

				B. P. Bidstrup Coronary Artery Bypass Graft Patency Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 1997; 1(4): 282 - 287. [Abstract] [PDF]

				J.-F. Hardy, S. Belisle, D. Robitaille, J. Perrault, M. Roy, and L. Gagnon MEASUREMENT OF HEPARIN CONCENTRATION IN WHOLE BLOOD WITH THE HEPCON/HMS DEVICE DOES NOT AGREE WITH LABORATORY DETERMINATION OF PLASMA HEPARIN CONCENTRATION USING A CHROMOGENIC SUBSTRATE FOR ACTIVATED FACTOR X J. Thorac. Cardiovasc. Surg., July 1, 1996; 112(1): 154 - 161. [Abstract] [Full Text]