The effects of aprotinin and tranexamic acid on thrombin generation and fibrinolytic response after cardiac surgery

Abstract

Thrombin formation is inevitable in coronary artery bypass surgery when CPB is used. The suppression of fibrinolytic activity, either with aprotinin or with tranexamic acid interferes with the hemostatic balance as evaluated by biochemical markers. Further investigations are needed to define the role of hemostatic activation in ischemic complications associated with cardiac surgery.

The Risk-Benefit Profile of Aprotinin Versus Tranexamic Acid in Cardiac Surgery

“…3 Aprotinin also attenuates fibrinolysis by inhibiting the action of plasmin, 3 but it does this more efficiently by forming reversible enzyme inhibitor complexes. 4 Unlike the lysine analogues, aprotinin simultaneously inhibits other serine proteases, such as thrombin and kallikrein, thereby enhancing its hemostatic effects and conferring it antiinflammatory effects. 5,6 The relative risk-benefit profile of these drugs is controversial.…”

Tranexamic acid does not correct the haemostatic impairment caused by hydroxyethyl starch (200 kDa/0.5) after cardiac surgery

“…The activation of the fibrinolytic system has been shown by elevated levels of fibrin degradation products and plasmin/ antiplasmin complexes at the postoperative phase of cardiac surgery [4]. Thrombelastography has been recommended for monitoring the fibrinolytic status after cardiac surgery [10].…”

“…The release of plasmin during CPB activates fibrinolysis and may contribute to platelet dysfunction [1]. A substantial number of clinical studies assessing antifibrinolytic strategies to decrease perioperative bleeding have been published [2][3][4].…”

The anesthetic experience of implantable left ventricular assist device insertion: a case report

“…In addition, deficiency in coagulation factors results from congestive hepatic failure as a complication of cardiac failure [6]. Transfusion of RBCs has demonstrated to worsen the surgical outcome and so antifibrinolytics or recombinant factor VII might be considered to treat coagulopathy and to decrease aggressive transfusion [9,10]. …”