Quick Links Introduction Lysine Analogs Aprotinin Comparison Studies Summary References Introduction Pharmacologic approaches to reduce bleeding and transfusion in cardiac surgical patients are based on either preventing the defects associated with the cardiopulmonary bypass CPB induced coagulopathy. Different pharmacologic agents have been reported, however the currently accepted pharmacologic interventions are based on using a protease inhibitor, aprotinin, or lysine analogs to inhibit fibrinolysis. These agents will be reviewed. Both of these drugs inhibit the proteolytic activity of plasmin and the conversion of plasminogen to plasmin by plasminogen activators.
Plasmin cleaves fibrinogen and a series of other proteins involved in coagulation.
Tranexamic acid is 6 to 10 times more potent than e-aminocaproic acid. Vander Salm recently reported a reduction in chest tube drainage in 51 patients who received EACA 4 . In addition, there were no differences in platelet function between EACA and the placebo group, and no differences in blood transfusion. Horrow later studied TA given in a prophylactic manner prior to skin incision for primary CABG surgery 5 . The 12 hour postop blood loss was 496 ml in the TA group compared to 750 ml in the placebo group.