Antifibrinolytic agents in current anaesthetic practice

Br J Anaesth. 2013 Oct;111(4):549-63. doi: 10.1093/bja/aet154. Epub 2013 May 9.


Antifibrinolytic drugs have become almost ubiquitous in their use during major surgery when bleeding is expected or commonplace. Inhibition of the fibrinolytic pathway after tissue injury has been consistently shown to reduce postoperative or traumatic bleeding. There is also some evidence for a reduction of perioperative blood transfusion. However, evidence of complications associated with exaggerated thrombosis also exists, although this appears to be influenced by the choice of the individual agent and the dose administered. There is controversy over the use of the serine protease inhibitor aprotinin, whose license was recently withdrawn but may shortly become available on the market again. In the UK, tranexamic acid, a tissue plasminogen and plasmin inhibitor, is most commonly used, with evidence for benefit in cardiac, orthopaedic, urological, gynaecological, and obstetric surgery. In the USA, ε-aminocaproic acid, which also inhibits plasmin, is commonly used. We have reviewed the current literature for this increasingly popular class of drugs to support clinical judgement in daily anaesthetic practice.

Keywords: antifibrinolytic agents; cardiac surgical procedures; hepatectomy; intracranial haemorrhages; liver transplantation; orthopaedics; post partum haemorrhage; postoperative haemorrhage; wounds and injuries.

Publication types

  • Review

MeSH terms

  • Aminocaproic Acid / adverse effects
  • Aminocaproic Acid / therapeutic use
  • Antifibrinolytic Agents / adverse effects
  • Antifibrinolytic Agents / therapeutic use*
  • Aprotinin / adverse effects
  • Aprotinin / therapeutic use
  • Blood Loss, Surgical / prevention & control
  • Cardiac Surgical Procedures / adverse effects
  • Female
  • Hemorrhage / drug therapy
  • Humans
  • Liver / surgery
  • Neurosurgical Procedures / adverse effects
  • Orthopedic Procedures / adverse effects
  • Postoperative Hemorrhage / prevention & control*
  • Postpartum Hemorrhage / drug therapy
  • Pregnancy
  • Tranexamic Acid / adverse effects
  • Tranexamic Acid / therapeutic use
  • Wounds and Injuries / complications


  • Antifibrinolytic Agents
  • Tranexamic Acid
  • Aprotinin
  • Aminocaproic Acid