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. 2024 Apr;46 Suppl 1(Suppl 1):S40-S47.
doi: 10.1016/j.htct.2024.02.011. Epub 2024 Mar 13.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Antifibrinolytics

Juan Carlos Montano-Pedroso  1 , Fernanda Vieira Perini  2 , Enis Donizetti  3 , Luciana Correa Oliveira  4 , Roseny Dos Reis Rodrigues  5 , Silvia Renata Cornélio Parolin Rizzo  6 , Guilherme Rabello  7 , Dante Mario Langhi Junior  8
Affiliations

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Antifibrinolytics

Juan Carlos Montano-Pedroso et al. Hematol Transfus Cell Ther. 2024 Apr.

Abstract

The use of strategies to reduce blood loss and transfusions is essential in the treatment of surgical patients, including in complex cardiac surgeries and those that use cardiopulmonary bypass. Antifibrinolytics, such as epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA), are widely used in these procedures, as well as in other types of surgeries. These medicines are included in the World Health Organization (WHO) list of 'essential medicines'. Scientific evidence demonstrates the effectiveness of EACA in reducing bleeding and the need for transfusions in heart surgery. EACA is highly recommended for use in heart surgery by the American Society of Anesthesiology Task Force on Perioperative Blood Management. Regarding the safety of EACA, there is no robust evidence of any significant thrombotic potential. TXA has also been shown to be effective in reducing the use of blood transfusions in cardiac and non-cardiac surgeries and is considered safer than other antifibrinolytic agents. There is no evidence of any increased risk of thromboembolic events with TXA, but doses greater than 2 g per day have been associated with an increased risk of seizures. It is also important to adjust the dose in patients with renal impairment. In conclusion, antifibrinolytics, such as EACA and TXA, are effective in reducing blood loss and transfusion use in cardiac and non-cardiac surgeries, without causing serious adverse effects.

Keywords: Aminocaproic acid; Antifibrinolytic; Aprotinin; Evidence-based medicine; Tranexamic acid.

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Conflict of interest statement

Conflicts of interest The author declares no conflicts of interest.

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