Antifibrinolytics for Cardiac Surgery: Which Agent Is Best?

To minimize bleeding during cardiac surgery, surgeons have employed one of three antifibrinolytic agents: a serine protease inhibitor (aprotinin) and two lysine analogues (tranexamic acid and aminocaproic acid). All three have been shown in placebo-controlled trials to be effective in reducing the need for blood transfusion, but their comparative effectiveness has not been well studied, and questions have been raised about aprotinin’s safety (the drug has been suspended from marketing in the U.S. since October 2007). In the Blood Conservation Using Antifibrinolytics in a Randomized Trial (BART), investigators randomized patients undergoing high-risk cardiac surgery to one of the three agents. The primary outcome was massive postoperative bl…