ANTIFIBRINOLYTIC DRUGS AND PERIOPERATIVE HEMOSTASIS

Although excessive bleeding is widely recognized as a common complicat ion of cardiac surgery, the recent success of antifibrinolytic drugs a s prophylactic hemostatic agents has received little attention outside the surgical literature. The etiology of the coagulopathy following c ardiac surgery is clearly multifactorial; however, the success of anti fibrinolytic drugs as hemostatic agents suggests that fibrinolysis con tributes to bleeding in this setting. Increasingly widespread administ ration of these drugs necessitates increased awareness of the risks an d benefits posed by perioperative antifibrinolytic therapy. The object ives of this review are to understand the mechanisms of action of anti fibrinolytic drugs in the context of the normal hemostatic response an d to review evidence pertaining to the efficacy and safely of antifibr inolytic drugs as hemostatic agents during cardiac surgery. (C) 1977 W iley-Liss, Inc.