Table 1.

Antifibrinolytic agents: drugs description, doses, and mechanisms of action.

Drug	Composition	Mechanism of Action	Elimination	Pharmaco-dynamics	Suggested Dosing in Adults	Approval
Aprotinin	Protein, isolated from bovine lung tissue	protease inhibitor Reversibly complexes with the active sites of plasmin, kallikrein, and trypsin Inhibition of: fibrinolysis, factor XIIa induced contact activation, thrombin induced platelet activation inflammatory response	predominantly proteolysis, ~60% % renal	initial plasmaT½ 150 min, terminal T½ life 10 h	“Full Dose”: 2× 106 KIU bolus patient, 2× 106 KIU bolus CPB, continuous infusion of 5×105 KIU “Half Dose”: 1×106 KIU bolus patient, 1×106 KIU bolus CPB, continuous infusion of 2.5×105 KIU	suspended since 2008; suspension lifted in Canada in 2011 and Europe in 2012 In the US still suspended
Tranexamic Acid	synthetic lysine analogue	antifibrinolytic; competitive inhibition of the activation of plasminogen to plasmin	renal	plasma ½ life 3 h	“High Dose”: 30 mg/kg bolus patient, 2 mg/kg CPB, continuous infusion of 16mg/kg “Low Dose”: 10 mg/kg bolus patient, 1-2 mg CPB, continuous infusion of 1 mg/kg	US, Canada, Europe
Epsilon Aminocaproic Acid	synthetic lysine analogue	antifibrinolytic: competitive inhibition of the activation of plasminogen to plasmin	renal	plasma T½ life 2 h	100 mg/kg bolus patient, 5 mg/kg CPB, continuous infusion of 30 mg/kg	US, Canada

From reference ⁵ (Anesthesiology. 2015;123(1):214-21).