Antifibrinolytics in Cardiac Surgery: What Is the Best Practice in 2022?

Purpose of Review This review describes the latest information related to the administration of lysine analogues during cardiac surgery. An awareness of appropriate antifibrinolytic administration will maximize benefit for blood conservation efforts and possibly decrease morbidity and mortality. Recent Findings Recent pharmacodynamic assessments for antifibrinolytics are more sensitive. Research suggests that lower dose regimens may not provide maximal inhibition of fibrinolysis but may be equally effective in decreasing transfusion of blood products. Effective lower dose regimens may decrease the incidence of seizures and possibly morbidity and mortality. Summary The lysine analogues are a key addition to blood conservation efforts in cardiac surgery. Finding an optimized dosing regimen is complex and may include factors such as total dosage and timing of administration. Understanding of the pharmacokinetics and pharmacodynamics of these drugs will help perioperative physicians evaluate their own practice and improve their own regimens.