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Revista Brasileira de Anestesiologia
On-line version ISSN 1806-907X
SANTOS, Ari-Tadeu Lírio dos; SPLETTSTOSSER, João Carlos; WARPECHOWSKI, Paulo and GAIDZINSKI, Mariana Mariz Pinto. Antifibrinolytics and cardiac surgery with cardiopulmonary bypass. Rev. Bras. Anestesiol. [online]. 2007, vol.57, n.5, pp. 549-564. ISSN 1806-907X. http://dx.doi.org/10.1590/S0034-70942007000500011.
BACKGROUND AND OBJECTIVES: Cardiac surgery is the surgical subspecialty most often associated with bleeding, bleeding disorders, and the need of blood products. Agents such as aprotinin, episilon-aminocaproic acid, and tranexamic acid are frequently used to aid the hemostasis of patients undergoing cardiopulmonary bypass. The objective of this report is to present the physiopathology of bleeding during cardiac surgeries and the current role of antifibrinolytics regarding their efficacy and complications when used in those procedures, with emphasis on tranexamic acid and aprotinin. CONTENTS: The mechanisms of changes in hemostasis caused by cardiopulmonary bypass, how antifibrinolytics decrease bleeding, and the use of alogenic blood in cardiac surgery are discussed. A review of the literature emphasizes the thromboembolism secondary to the use of those antifibrinolytics. CONCLUSION: Fibrinolysis is one of the main factors related with increased bleeding during cardiac surgery with cardiopulmonary bypass. Inhibition of fibrinolysis associated with the preservation of platelet function is, probably, the mechanism by which anti-fibrinolytics decrease bleeding. Those agents reduce bleeding in up to 50% in cardiac surgeries with cardiopulmonary bypass. Tranexamic acid and episilon-aminocaproic acid are safer than aprotinin in the prevention of thromboembolism.
Keywords : BLOOD [coagulation]; DRUGS, Antifibrinolytic agents [aprotinin, epsilon-aminocaproic acids, tranexamic acid]; SURGERY, Cardiac [cardiopulmonary bypass].