• Jerrold H Levy, Andreas Koster, Quintin J Quinones, Truman J Milling, and Nigel S Key.
• From the Division of Cardiothoracic Anesthesiology and Critical Care, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina (J.H.L, Q.J.Q.); Institute of Anesthesiology, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Ruhr-University Bochum, Bochum, Germany (A.K.); Seton Dell Medical School Stroke Institute, Austin, Texas (T.J.M.); and the Department of Medicine, Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina (N.S.K.).
• Anesthesiology. 2018 Mar 1; 128 (3): 657670657-670.

AbstractFibrinolysis is a physiologic component of hemostasis that functions to limit clot formation. However, after trauma or surgery, excessive fibrinolysis may contribute to coagulopathy, bleeding, and inflammatory responses. Antifibrinolytic agents are increasingly used to reduce bleeding, allogeneic blood administration, and adverse clinical outcomes. Tranexamic acid is the agent most extensively studied and used in most countries. This review will explore the role of fibrinolysis as a pathologic mechanism, review the different pharmacologic agents used to inhibit fibrinolysis, and focus on the role of tranexamic acid as a therapeutic agent to reduce bleeding in patients after surgery and trauma.

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