Anti-Fibrinolytic Drugs Beneficial in Surgery Patients

Studies show reduced need for blood transfusions during and after surgery

FRIDAY, Oct. 19 (HealthDay News) -- Anti-fibrinolytic drugs reduce the need for blood transfusions during and after surgery without increasing the risk of thrombosis, according to a review published online Oct. 17 in the Cochrane Database of Systematic Reviews.

D.A. Henry, and colleagues from the Cochrane Collaboration in Oxford, United Kingdom, analyzed data from 211 randomized controlled trials involving three anti-fibrinolytic drugs in 20,781 adults undergoing non-urgent surgery.

The researchers found that aprotinin appeared to be superior to the lysine analogues tranexamic acid and epsilon aminocaproic acid in reducing the need for a red blood cell transfusion (relative risk 0.83). Aprotinin also reduced the risk of re-operation due to bleeding (RR, 0.48, absolute risk reduction under 3 percent). The risks of myocardial infarction, stroke, renal dysfunction and overall mortality did not increase in patients receiving aprotinin. "However, the apparent advantage of aprotinin over the lysine analogues was small and may be explained by publication bias and non-equivalent drug doses," they note.

"Anti-fibrinolytic drugs provide worthwhile reductions in blood loss and the need for allogeneic red cell transfusion," Henry and colleagues conclude. "In most circumstances the lysine analogues are probably as effective as aprotinin and are cheaper; the evidence is stronger for tranexamic acid than for aminocaproic acid."

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