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Antifibrinolytic — Cardiac Surgery

Aprotinin

Brand names: Trasylol

Aprotinin is an antifibrinolytic serine protease inhibitor used to reduce blood loss and transfusion requirements in selected patients undergoing cardiac surgery with cardiopulmonary bypass.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It inhibits plasmin and other serine proteases, stabilising clot formation and reducing fibrinolysis.

Prescribing in practice

  • Anaphylactic and anaphylactoid reactions can occur, particularly on re-exposure, so a test dose and resuscitation facilities are required and prior exposure should be checked.
  • Use is restricted to defined cardiac surgical indications under specialist guidance following its earlier safety-driven suspension.
  • It is administered intravenously by experienced anaesthetic or surgical teams only.

Monitoring

Monitor for hypersensitivity reactions, renal function and coagulation parameters during and after administration.

Counselling the patient

  • The anaesthetic and surgical team should document any previous exposure to aprotinin.
  • Staff should observe closely for allergic reactions, especially at the start of administration.
  • Renal function should be reviewed after surgery.

Evidence & guidelines

Aprotinin was reintroduced for cardiac surgery following European regulatory re-evaluation of the BART trial and related data.

Reference: Trasylol SPC; BART Trial (2007); MHRA Safety Advice; ESA Perioperative Haemostasis Guidelines 2022; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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