DEVELOPMENT OF OTHER THERAPIES In addition to specific factor concentrates, the development of a small number of other therapies has contributed enormous benefit for prevention or treatment of bleeding episodes in persons with hemophilia. The efficacy of the fibrinolytic inhibitor epsilon-aminocaproic acid in dental extractions was first reported from the Cardeza Foundation in Philadelphia in 1964.63 Epsilonaminocaproic acid is still a mainstay for adjuvant therapy of mucus membrane bleeding including mouth and gum bleeding and menorrhagia. A controlled trial of the fibrinolytic inhibitor tranexamic acid was reported in 1973.64 Trajexamic acid causes less gastrointestinal distress as compared with epsilon-aminocaproic acid and is equally effective. 1-Deamino-8-D-arginine vasopressin DDAVP ; , a synthetic vasopressin, was found to increase plasma levels of FVIII and von Willebrand factor in patients with mild hemophilia A and von Willebrand disease.65 This nonblood-product therapy can be used for either prevention or treatment of bleeding in individuals with an adequate response. Seizures secondary to hyponatremia have been reported, especially in infants; accordingly, DDAVP is not recommended for children younger than the age of 2 years.66 Activated recombinant FVII rFVIIa ; was first successfully employed to control hemostasis in a hemophilia patient with inhibitory antibodies in 1991.67 rFVIIa has been demonstrated to bypass factors VIII and IX in the activation of FX on the platelet surface in the absence of tissue factor, and in addition, may aid tissue factor-mediated generation of activated FX.68 rFVIIa has become a first-line therapy for bleeding in children with inhibitors.69 Finally, a local hemostatic agent concocted from a combination of proteins including fibrinogen, thrombin, FXIII, and aprotinin was developed in Israel as a topical agent to promote hemostasis.70 Fibrin glue is particularly useful in oral bleeding.
Weston-Recreation Commission Continued ; Scaleback of sports opposed, H 7 15 87 p15 + Weston-Selectmen, Board of Board listens to options for ice skating rink plan, H 12 8 87 Board members approved, H 12 26 87 p14 Dispatch center given top priority: Selectmen study complaints, H 12 9 87 p35 Flynn reappointed, H 12 8 87 Funding approved for patient, H 4 9 87 p16 Gazebo gets green light from Weston selectmen, H 8 4 87 New pact approved for police, H 6 17 87 p41 + Selectmen adopt $5, 300, 295 budget, H 2 24 87 Selectmen approve outline of a garbage hauling pact, H 7 24 87 p11 Selectmen eye $10.9 million parcel, H 7 21 87 p13 Town hopes to increase community involvement, H 7 16 87 p13 + Weston joins rental assistance program, H 12 22 87 p15 + Weston selectmen agree town would be better off staying in health district, H 10 1 87 p13 Weston selectmen worried about teacher salary increases, H 2 18 87 p33 + Weston-Social Services, Dept. of Flores tries to address Weston's social issues, H 5 30 87 p15 Human services leaders discuss range of problems facing Weston [photo], H 2 28 87 Weston-Town Hall Architect rejects criticism of Town Hall drawings, H 7 11 87 p16 Dedication of addition set for Oct. 18, H 8 17 87 p13 + Mural will trace history for visitors to Town Hall [photo], H 4 9 87 p15 Town Hall addition nears completion, H 5 21 87 p54 Town Hall work creeps onward [photo], H 7 9 87 p15 Town seeks donors to get `chairborne', H 7 9 87 p16 Weston gallery awaits portrait of Hutchinson [photo], H 1 15 87 p13, for instance, tranexamic acid uk.
Henrik Husted; Lars Blnd; Stig Sonne-Holm; Gitte Holm; Tine W. Jacobsen; Peter Gebuhr Online Publication Date: 01 December 2003 To cite this Article: Husted, Henrik, Blnd, Lars, Sonne-Holm, Stig, Holm, Gitte, Jacobsen, Tine W. and Gebuhr, Peter 2003 ; 'Tranexamic acid reduces blood loss and blood transfusions in primary total hip arthroplasty', Acta Orthopaedica, 74: 6, 665 - 669 To link to this article: DOI: 10.1080 00016470310018171 URL: : dx.doi 10.1080 00016470310018171.
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Supply can be requested. Where one stop dispensing operates, the usual length of supply will be 28 days or nearest original pack size, unless specified otherwise. Self-medication supplies issued to patients must be kept in a locked cabinet and the patient should be allocated a key. Where one stop dispensing operates, medication supplies are always kept in the patient's locked cabinet. The key to the cabinet will only be issued to the patient from stage 2 of the self-medication programme onwards. Loss of medication or the key must be immediately reported to the nurse in charge who will investigate and take appropriate action. Depending on the circumstances, this may include contacting the charge nurse on call for the hospital, the pharmacist or the police. An incident report must be completed. When patients commence the self-medication programme, a yellow self-medication sticker should be attached to the current prescription sheet and each administration recording sheet. The appropriate stage should be completed on the sticker and the sticker replaced when the patient changes to a new stage of the programme. `Selfmedication' and the stage should also be noted in the `comments on discrepancies' section of the administration recording sheet when the programme commences or stage changes. A medication chart appendix 4 ; , printed in Pharmacy, will be issued to the patient if requested. Where a patient is found to have problems in taking their medication, they may be held at a particular stage until the problems are resolved and improvement is observed. They may also be withdrawn from the programme altogether. The nurse in charge of the ward can decide to suspend or return the patient to a previous stage of the programme at any time of the day or night. This action and the patient's current stage on the programme must be reviewed at the next multidisciplinary team meeting.
Drug of Choice - Traenxamic Acid, 1g tds up to 1.5g qds during heavy day of bleeding. 2 ; Mirena 3 ; Mefenamic Acid 500mg tds especially if with associated pain ; . 4 ; Combined Oral Contraceptive if no contra-indications ; . 5 ; Danazol 200mg daily, for three months and
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Wednesday, april 5, 2006 amendment proposed, carried over 1163 word version ; - senators sheheen, reese, hutto and elliott: a bill to amend the code of laws of south carolina, 1976, by adding chapter 81 to title 15 so as enact the successor asbestos-related liability fairness act , to define certain terms related to asbestos-related claims, to limit successor asbestos-related liabilities of a corporation under certain circumstances, to provide exceptions to the limitations on successor liability, and to provide a method for establishing the fair market value of total gross assets in determining the limitations on successor liability and
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Author Affiliations Russell A. Wilke, MD, PhD, Department of Internal Medicine, Marshfield Clinic, and Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, Wisconsin Richard L. Berg, MS, Biostatistics and Bioinformatics Core, Marshfield Clinic Research Foundation, Marshfield, Wisconsin Humberto J. Vidaillet, MD, Department of Cardiology, Marshfield Clinic, Marshfield, Wisconsin Michael D. Caldwell, MD, PhD, Department of Surgery, Marshfield Clinic, Marshfield, Wisconsin James K. Burmester, PhD, Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, Wisconsin Michael A. Hillman, MD, MBA, Care Management, Marshfield Clinic, Marshfield, Wisconsin.
LOUISIANA MEDICAID PROGRAM ISSUE DATE: 12 01 05 PROVIDER MANUAL REVISED DATE: CHAPTER 37: PHARMACY BENEFITS MANAGEMENT SERVICES SECTION: 37.11 PUBLIC HEALTH SERVICES 340B DRUG PRICING PROGRAM and
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O. Single-dose tranexamic acid reduces postoperative bleeding after coronary surgery in patients treated with aspirin until surgery. Anesth Analg 2003; 96: 923-8. Boeken U, Eisner J, Feindt P, Petzold TH, Schulte HD, Gams E. Does the time of resternotomy for bleeding have any influence on the incidence of sternal infections, septic courses or further complications? Thorac Cardiovasc Surg 2001; 49: 458. Moulton MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M. Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations. J Thorac Cardiovasc Surg 1996; 111: 1037-46. Lin CH, Hsu RB, Chang SC, Lin FY, Chu SH. Poststernotomy mediastinitis due to methicillin-resistant Staphylococcus aureus endemic in a hospital. Clin Infect Dis 2003; 37: 67984. Harder S, Thurmann P. Economic aspects of drug therapy in hospitals: an issue for clinical pharmacologists. Int J Clin Pharmacol Ther 1994; 32: 215-8.
Moderate consumption of alcohol 14 units per week for females and 21 units per week for males ; appears to give some protection against CHD. This may be due to its HDL cholesterol raising properties and ability to reduce clotting tendency. Red wine also contains natural anti oxidant compounds which may also be cardioprotective. However the main benefit appears to be from the alcohol itself rather than the components of each type of drink. Alcohol consumption higher than these recommended levels is associated with increased CHD mortality and morbidity. Advise the patient that the suggested benefits from regular alcohol consumption are controversial Men should drink no more than 4 units a day and a total of no more than 21 units a week. Women should drink no more than 3 units a day, and a total of no more than 14 units of alcohol a week. Patients with heart failure or any other medical contra-indications should be advised not to drink at all. Patients who are trying to reduce their weight need to be reminded that alcohol is high in calories and misoprostol.
Nosis of vWD. The patients were treated with either a protocol that includes the use of desmopressin acetate and tranexamic acid 37 children ; or factor VIII concentrate in children with a positive history of seizures 4 children.
Interferon beta-1a ; : This drug is produced by Biogen Idec and is administered weekly, intramuscularly. Avonex services offer the following: Personal nurses for in-home training Around-the-clock support at 800-456-2255 Reimbursement and insurance information Mentoring program Educational materials For more information on services available, go to avonex and calcitriol.
C.01.065. No person shall sell a drug that is prepared for ophthalmic or parenteral use unless a representative sample of each lot of the drug in its immediate container a ; b ; is tested by an acceptable method for identity, and the drug is found to be true to its proper name, or to its common name if there is no proper name; is tested by an acceptable method for sterility, except i ; for living vaccines, or ii ; where the manufacturer has submitted evidence, satisfactory to the Director to prove that processing controls ensure the sterility of the drug in its immediate container, and the drug is found to be sterile; and is subjected to such further tests satisfactory to the Director to ensure that the drug is safe to use according to directions, for example, glutathione tranexamic acid.
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Gastrointestinal tract bleeding.78 The normal route of administration is either oral or intravenous; to our knowledge, local 848 intrapleural use has not been reported. Tranexamic.
| Tranexamic treatmentIf any of these events occur, any rt-PA infusion should be stopped and the patient examined for possible reasons for the deterioration. Blood should be taken to measure prothrombin time PT ; , activated partial thromboplastin time APPT ; , fibrinogen, full blood count and group and save serum. CT scanning must be performed immediately, irrespective of the allocated treatment group. If CT scanning confirms intracranial haemorrhage, rt-PA must not be restarted. Management should follow local protocols and will usually require consultation with a haematologist and a neurosurgeon. For patients who have received rt-PA there is no reliable evidence available to recommend any one treatment strategy over another, but fibrinolytic inhibitors such as tranexamic acid may be useful. In the rare instance that fibrinogen levels are low 1g L ; after rt-PA therapy, cryoprecipitate containing fibrinogen and factor VIII ; may be required. 34 ; Fibrinogen assays vary but the Clauss technique is considered the best method if available. 35 ; Asymptomatic intracranial bleeding If asymptomatic intracranial bleeding haemorrhagic transformation of the infarct or parenchymatous haematoma ; is detected on the repeat CT scan performed at about 24 hours after randomisation, no specific action is needed, but it may be necessary to delay the start of long-term antiplatelet or anticoagulant therapy. The degree of delay is a matter for the responsible clinician to determine, but will be influenced by factors such as the degree and extent of haemorrhage, the patient's clinical condition, the nature of the planned treatment and the indication for its use and tegretol.
Serum .0.000 Pro-uPA serum .1.288 Pro-uPA serum tranexamic acid.0.000 Pro-uPA serum goat anti-uPA.0.000 Pro-uPA serum aprotinin .0.050.
Perforation Rate 1: 1000 insertions. Incidence is related to skill of inserter, timing of insertion more common in the early post natal period in lactating women ; and the condition of the uterine wall. Often is unnoticed. It can be removed by laparoscopy if detected early, but adhesions eventually develop with time and laparoscopy laparotomy may be required. Note: The Faculty of Family Planning and Reproductive Heath Care award a recertifiable Letter of Competence for Intra-uterine Techniques LoC IUT ; For medico legal reasons all clinicians should hold a valid LoC IUT and be able to provide evidence of the quality of the service they provide. Contraindications: General: -Pregnancy, current or high risk of STI, unexplained genital tract bleeding, distorted uterine cavity, heart valve disease, Copper devices: - heavy painful periods, allergy to copper LNG IUS: Hypersensitivity to levonorgestrel Not contraindicated for nulliparous women or women with HIV infection no evidence of increased transmission of the virus nor decrease in effectiveness of the device ; . Pre-insertion Screening: Taking a sexual history prior to insertion will identify women at high risk of STI. They should be offered full screening and counselled appropriately. 1996 RCOG study group on the prevention of pelvic infection recommend "Non pregnant women aged under 35 years undergoing uterine instrumentation eg IUD insertion ; should be screened for infection Chlamydia, GC or BV ; or receive prophylactic antibiotics." Treatment regime - Azithromycin 1 gram stat orally or Doxycycline 100mg orally BD for 7 days plus Metronidazole 1 gram rectal suppository. Contact tracing must be done for all women with positive results. When to insert: Routine within first 12 days of the menstrual cycle or up to days after the earliest expected ovulation ; and is effective immediately. Any time in the cycle if there has been no risk of pregnancy. Post Natal 4 weeks after normal vaginal delivery 6-8 weeks after LSCS LNG IUS Day 1-7 of menstrual cycle. If inserted at any other time must ensure there has been no risk of pregnancy and advise no intercourse use of alternative method for 7 days. Follow-up: At 6 weeks then 3 months post insertion. Annual checks may not be essential in an asymptomatic risk free woman who checks her threads regularly. Management of Problems: Menstrual problems Exclude infection or other gynaecological causes. Treat symptomatically with non steroidal anti-inflammatory drugs Tranexwmic acid. Check for anaemia. Lost threads Exclude pregnancy. Recommend alternative protection. Explore canal for thread, refer for scan x-ray to locate the device. Pregnancy Exclude ectopic pregnancy. Outline the risks to a pregnancy if the device is left in situ increased risk of mid trimester abortion, pre-term delivery, infection ; . If possible, remove the IUD at the earliest possible opportunity even if the woman is considering termination of the pregnancy. Removal Change of device Ideally with menstrual period no intercourse from day 1 ; OR any time if there has been no intercourse within the previous 7 days. Consider emergency contraception and carbimazole and tranexamic.
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The online survey was open not only to IFPMA member companies, but to all major research-based pharmaceutical companies and IFPMA country associations' member companies. Respondents were invited to provide data for the five years from the launch of the MDGs to 2005 on currently active projects, and they were also invited to submit data and information on any projects in the previous 10 years that would be relevant to the MDGs. For each question where this was appropriate, the respondents were required to state whether the answer should be treated as confidential. No other company or the public would be given access to confidential data. The survey was live online between June and August 2005, and, in the final quarter of 2005, IFPMA researchers engaged in follow-up discussions with respondents on the data that they had been provided with. The 17 companies that completed surveys themselves do appear to encompass the best-known health partnership initiatives. The company responses were supplemented with those that came through the involvement of IFPMA country associations. 3.2. Data sources The main units of measurement decided upon to provide a global measure of the industry's contribution comprise both an assessment of cumulative financial value and an assessment of the number of positive health interventions achieved. In order to achieve a robust and consistent basis for these measures the IFPMA asked those completing the questionnaires to use wholesale acquisition cost WAC ; to value donated products, as the closest to an industry-standard "wholesale list price". They adjusted data on the number of beneficiaries to comply with their own definition of a positive health interventioniii, relating either to delivery of sufficient medicines or vaccines to cure one person of one disease, or to manage or prevent a disease for a year. In addition, in order to include public health measures, a proven program of health education for one person was also assessed as a single positive health intervention. LSEHSC have had access to two spreadsheets containing the survey data. The first was provided in October 2005, and the final version dates from December 2005. Companies were given the option of providing data on their programs in confidence, and most decided to do so, so that the IFPMA could only publish the aggregated totals. The spreadsheets were, therefore, provided to LSEHSC in confidence for.
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Levi M, Cromheecke ME, de Jonge E, et al. Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints. Lancet 1999; 354: 194047. Karkouti K, Beattie WS, Dattilo KM, et al. A propensity score case-control comparison of aprotinin and tranrxamic acid in high-transfusion-risk cardiac surgery. Transfusion 2006; 46: 32738. Mangano DT, Tudor IC, Dietzel C for the Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation. The risk associated with aprotinin in cardiac surgery. N Engl J Med 2006; 354: 35365.
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Management of patients with acquired angioedema should cover their acute and longer term needs. Initially, consideration should be given to a course of tranexsmic acid. Antifibrinolytic agents inhibit plasminogen activation with consequent sparing of C1 inhibitor usage. If trnexamic acid is ineffective, attenuated androgens increase the hepatic production of C1 inhibitor protein.12 Danazol is known to increase C1 esterase inhibitor activity.13 Steroids, antihistaminics and epinephrine have limited effect in these conditions. 14 In an acute emergency C1 inhibitor concentrate may be used but patients may be resistant to this form of replacement therapy.16 Selfadministration of C1-inhibitor concentrate could be a valuable and convenient treatment modality to prevent or treat angioedema attacks in patients with C1-inhibitor deficiency.15 Rituximab is a monoclonal antibody against CD20 transmembrane protein on the surface of mature and malignant B cells which has been used for the treatment of acquired angioedema in association with systemic lupus erythematosus.17 It is also an active agent in the treatment of chronic lymphocytic leukaemia.18 Four weekly infusions of rituximab are used to treat acquired angioedema due to the presence of C1-inhibitor autoantibody.19 Hence, we used rituximab to target the chronic lymphocytic leukaemia and the acquired angioedema. In the future newer products should be considered including genetically engineered C1 esterase inhibitors, kallikrein inhibitors and bradykinin B2 receptor antagonists.20.
Marc Romney Department of Medical Microbiology St. Paul's Hospital Vancouver, BC References.
LPS injection was associated with a transient rise in the plasma concentration of TNF, IL-6, IL-8, and IL-10, peaking after 2 to 3 hours all P 0.001 versus baseline ; . Tranxamic acid infusion did not influence these LPS-induced cytokine responses Figure 6.
With the advent of large-scale buprenorphine naltrexone Suboxone ; prescribing in the United States, health-care providers should be cognizant of the potential lethality of the concomitant use of buprenorphine and high-dose benzodiazepines. The mortality rate from buprenorphine might be higher due to the complicated extraction process and the high level of suspicion related to identification and
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The bioavailability is approximately 35 % in the dosage range 0, 5-2 g and is not affected by simultaneous food intake. Following a single dose Cmax and urinary excretion increased linearly with doses between 0, 5 g and 2, 0 g. Following a single dose of 0, 5 g Cmax is approximately 5 microg ml and after a dose of 2 g Cmax is 15 microg ml. Therapeutic concentration in plasma is maintained up to 6 hours after an oral single dose of 2 g. Plasma protein binding plasminogen ; is approximately 3 % at therapeutic levels. Plasma clearance is approximately 7 l h. Halflife in plasma is approximately 2 hours after an intravenous single dose. Following repeated oral dosage the halflife is longer. The terminal halflife is about 3 hours. Approximately 95 % of absorbed dose is excreted unchanged in urine. Two metabolites have been identified: a N-acetylated and a deaminated derivative. Impaired renal function Impaired renal function constitutes a risk of accumulation of tranexamic acid. 5.3 Preclinical safety data.
REFERENCES Barrons RW, Jahr JS. 1996 ; A review of post-cardiopulmonary bypass bleeding, aminocaproic acid, tranexamic acid, and aprotinin. J Ther.; 3: 82138. MEDLINE Bellavite P, Andrioli G, Guzzo P, Chirumbolo S, Manzato F, Santonastaso C. 1994 ; A colorimetric method for the measurement of platelet adhesion in microtiter plates. Anal Biochem.; 216: 44450. MEDLINE Bergmeyer HU, Bernt E, Hess B. 1965 ; Lactate dehydrogenase. In Methods of Enzymatic Analysis. Bergmeyer HU, ed, p 736. Academic Press Inc., New York. Born GVR. 1963 ; Quantitative investigation into aggregation of blood platelets. J Physiol.; 168: 17895. MEDLINE Cardinal DC, Fower RJ. 1980 ; The electronic aggregometer: a novel device for assessing platelet behavior in blood. J Farmacol Methods.; 3: 13543. Chrono-Log Corp. 1987 ; Manual for Testing with the Whole-blood Aggregometer Model 550. Havertown, PA. DelRossi AJ, Cernainau AC, Botros S, Lemole GM, Moore R. 1989 ; Prophylactic treatment of postperfusion bleeding using EACA. Chest.; 96: 2730. MEDLINE Dunn CJ, Goa KL. 1999 ; Yranexamic acid. A review of its use in surgery and other indications. Drugs.; 57: 100532. MEDLINE Green D, Ts'ao CH, Cerullo L, Cohen I, Ruo TI, Atkinson AJ. 1985 ; Clinical and laboratory investigation of the effects of epsilon-aminocaproic acid on hemostasis. J Lab Clin Med.; 105: 3217. MEDLINE Hardy J. 1992 ; Natural and synthetic antifibrinolytics in cardiac surgery. Can J Anaesth.; 39: 35365. MEDLINE Heemskerk J, Bevers E, Lindhout T. 2002 ; Platelet activation and blood coagulation. Thromb Haemost.; 88: 18693. MEDLINE Maciejewska D, Midura-Nowaczek K, Wawer I. 2002 ; Conformational analysis of in solution and solid state by 1H, 13C NMR spectroscopy and molecular modeling. J Mol Struct.; 604: 26978. Mannucci PM. 1998 ; Hemostatic drugs. N Engl J Med.; 339: 24553. MEDLINE Markwardt F. 1978 ; Fibrinolytics and antifibrinolytics. In Handbook of Experimental Pharmacology, vol 46. Springer, Berlin, Heidelberg, New York. Midura-Nowaczek K, Bruzgo I, Dubis E, Roszkowska-Jakimiec W, Worowski K. 1996 ; Antifibrinolytic activity of epsilon-aminocaproyl derivatives of amino acids. Pharmazie.; 51: 7757. MEDLINE Midura-Nowaczek K, Bruzgo I, Poplawski J, Roszkowska-Jakimiec W, Worowski K. 1998 ; Effects of epsilonaminocaproylaminoacids on fibrynolytic and caseinolytic activity of euglobulin fraction. Acta Pol Pharm.; 55: 15961. MEDLINE Monroe DM, Hoffman M, Roberts HR. 2002 ; Platelets and thrombin generation. Arterioscler Thromb Vasc Biol.; 22: 13819. MEDLINE Munoz JJ, Birkmeyer NJO, Birkmeyer JD, O'Connor GTO, Dacey LJ. 1999 ; Is epsilon-aminocaproic acid as effective as.
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TABLE 1. Histologic Score for Ischemlc Damage in Eight Brain Regions of Baciofen-Treated and Untreated Rats After 20 Minutes of Global Ischemia.
Where blood loss is chronic and specific measures to stop bleeding have not been successful then impairing fibrin dissolution with tranexamic acid which inhibits plasminogen activation and fibrinolysis may be helpful.
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LIVER DISEASE Patients with liver disease often have very complex coagulopathies, with bleeding often out of proportion to what would be expected from the INR and PTT. The management of the bleeding focuses on the specific problem encountered. Agents which may be used include: Product Quantity Indication Antifibrinolytic agents 15mg kg po 8 hourly Minor bleeds eg tranexamic acid eg epistaxis and gum bleeds. NB Contraindicated in DIC Fresh frozen plasma 15-20ml kg. Bleeding associated with Remember large volumes prolonged INR and PTT. are hazardous in patients with fluid overload and diuretic cover may be required. ; Cryoprecipitate 8-10 bags Hypofibrinogenaemia.
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Ties may be useful to decrease the thrombotic potential of blood and to reduce the decrease of platelet number. This is confirmed by the observation that prophylactic administration of EACA to patients undergoing various selective operations with cardiopulmonary bypass reduced the postoperative blood loss and preserved platelet function Markwardt, 1978; DelRossi et al., 1989 ; . The use of pharmacological therapies to reduce blood loss and blood transfusion in surgery has been restricted to a few drugs Barrons & Jahr, 1996; Mannucci, 1998; Munoz et al., 1999; Peters & Noble, 1999; Dunn & Goa, 1999; Porte & Leebeek, 2002 ; . Among the antifibrinolytic agents aprotinin, EACA and tranexamic acid have the best evidence supporting their use especially in cardiac surgery, liver transplantation and some orthopedic surgical procedures. Meta-analyses of randomised, controlled trials in cardiac patients have suggested that all the above mentioned drugs exhibit a comparable therapeutic value Munoz et al., 1999; Porte & Leebeek, 2002 ; . However, there is clinical evidence that supports.
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