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Uncontrollable bleeding is every physician’s and patient’s nightmare. Such bleeding can be due to disease, injury, surgery, or anticoagulant therapy and can arise from lesions in the brain, lung, liver, or gastrointestinal or genitourinary tract. Most clinicians’ initial responses are to transfuse blood, plasma, and platelets, but adjunctive pharmacologic therapy also is available. The efficacy and safety of some of these pharmaceutical agents were reviewed by two experts in blood coagulation. The agents considered were aprotinin, tranexamic acid, ϵ-aminocaproic acid (EACA), desmopressin, and recombinant factor VIIa (rFVIIa).
Aprotinin is a powerful protease inhibitor that is derived from bovine lung tissue; it limits clot dissolution …