Anti-fibrinolytic therapy in thoracic aortic surgery

Background. Bleeding is an important cause of morbidity in thoracic aortic surgery. il; Methods. We reviewed the mechanisms for fibrinolysis in aortic surgery and the propensity for intervention. Several studies have addressed the safety and efficacy of aprotinin. Results, The endothelium regulates the balance between thrombosis and fibri nolysis. During hypothermic circulatory arrest, thrombin generation stimula tes protein C production and tissue plasminogen activator release to promot e fibrinolysis. Hypothermia also adversely affects platelet function and co agulation. Controversy exists regarding the effectiveness and dangers of an tifibrinolytic agents after circulatory arrest. Conclusions. Fibrinolysis remains problematic during thoracic aortic aneury sm surgery. Heparin management is complicated by aprotinin and insufficient heparin may result in thrombotic events. Aprotinin is safe during rewarmin g or postoperatively. (C) 1999 by The Society of Thoracic Surgeons.