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)