Current opinion in hematology
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Antifibrinolytics are used to attenuate the coagulopathy associated with cardiopulmonary bypass. However, recent studies suggest that the antifibrinolytic aprotinin is associated with increased renal and vascular events and death compared to its alternatives. To develop a recommendation for antifibrinolytic use in adult cardiac surgery, we performed a systematic review and meta-analysis to determine the association of the antifibrinolytics with efficacy, safety and cost outcomes. ⋯ We support the targeted use of aprotinin in adult cardiac surgery patients at high risk for bleeding or stroke, and discourage the use of aprotinin in those at high risk for renal failure. Although fewer data are available for tranexamic and aminocaproic acid, we support their use as alternatives to aprotinin in those at high risk for bleeding.