Retrospective aprotinin cardiac surgical studies and their limitations: time for a prospective randomized clinical trial.

The article discusses the use of aprotinin, a pharmacologic agent that inhibits fibrinolysis, contact activation, and protease-activated receptors, in cardiac surgery patients. The European Medicines Agency suspended the marketing authorization of aprotinin in 2008 but reinstated it in 2016 for high-risk patients undergoing coronary artery bypass grafting. The article presents the results of a retrospective study comparing aprotinin with tranexamic acid in cardiac surgery patients, finding no differences in major bleeding or blood products transfused but an increased risk of thromboembolic events with aprotinin. The authors argue that more research, particularly prospective randomized clinical trials, is needed to evaluate the efficacy and safety of aprotinin and tranexamic acid in cardiac surgery. [Extracted from the article]