Pharmacological agents: antifibrinolytics and desmopressin

This article provides an overview of the scientific evidence regarding the efficacy and safety of antifibrinolytic agents and desmopressin to reduce surgical blood loss. The synthetic derivatives of lysine are the only antifibrinolytics available in clinical practice since the withdrawal of aprotinin. There is evidence that the prophylactic use of lysine analogues is efficacious in reducing perioperative blood loss in cardiac and major orthopaedic surgery. The impact on exposure to blood transfusion is, however, variable. There is no evidence at present that they improve the overall outcome. Lysine analogues appear to be well tolerated in coronary artery bypass surgery, but less is known regarding their risk–benefit profile in special patient groups. Further studies are needed to elucidate the best compromise between dosing regimen, efficacy and safety in various clinical settings. Desmopressin may reduce excessive bleeding and transfusion requirements in some specific patient populations with acquired platelet dysfunction, but this needs to be validated in future studies.