Newly Published
Review Article  |   December 2017
Antifibrinolytic Therapy and Perioperative Considerations
Author Notes
  • 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.).
  • Submitted for publication July 27, 2017. Accepted for publication October 2, 2017.
    Submitted for publication July 27, 2017. Accepted for publication October 2, 2017.×
  • Research Support: Support was provided from institutional and/or departmental sources and grant No. NIGMS T32 GM08600 from Duke University Medical Center, Durham, North Carolina (to Dr. Quinones) and grant No. NHLBI K23 1K23HL127227-01A1 from Seton Dell Medical School Stroke Institute, Austin, Texas (principal investigator: Truman J. Milling, Jr., M.D.).
    Research Support: Support was provided from institutional and/or departmental sources and grant No. NIGMS T32 GM08600 from Duke University Medical Center, Durham, North Carolina (to Dr. Quinones) and grant No. NHLBI K23 1K23HL127227-01A1 from Seton Dell Medical School Stroke Institute, Austin, Texas (principal investigator: Truman J. Milling, Jr., M.D.).×
  • Competing Interests: Dr. Levy serves on steering committees for Boehringer Ingelheim, CSL Behring, Grifols, and Instrumentation Labs, and on advisory committees for Leading Biosciences, Octapharma, Pfizer, and Portola. Dr. Milling is a member of a steering committee for Portola and is a consultant for CSL Behring. Dr. Key is a consultant for Bayer and CSL Behring and receives research support from Baxalta US Inc. The other authors declare no competing interests.
    Competing Interests: Dr. Levy serves on steering committees for Boehringer Ingelheim, CSL Behring, Grifols, and Instrumentation Labs, and on advisory committees for Leading Biosciences, Octapharma, Pfizer, and Portola. Dr. Milling is a member of a steering committee for Portola and is a consultant for CSL Behring. Dr. Key is a consultant for Bayer and CSL Behring and receives research support from Baxalta US Inc. The other authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Levy: Department of Anesthesiology, 2301 Erwin Road, Box 3094, Duke University Medical Center, Durham, North Carolina 27710. jerrold.levy@duke.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Review Article / Coagulation and Transfusion
Review Article   |   December 2017
Antifibrinolytic Therapy and Perioperative Considerations
Anesthesiology Newly Published on December 7, 2017. doi:10.1097/ALN.0000000000001997
Anesthesiology Newly Published on December 7, 2017. doi:10.1097/ALN.0000000000001997
Abstract

Fibrinolysis 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.