Should antifibrinolytics be used in orthopaedic surgery?

Greater appreciation of the risks of blood transfusion, coupled with concerns about the future availability and cost of donor blood, have led to increased interest in techniques to reduce transfusion requirements. Aprotinin and tranexamic acid are antifibrinolytic agents which are used to reduce blood loss. In cardiac surgery aprotinin has been shown to reduce blood transfusion requirements and mortality without any increase in thrombotic complications. Although less evidence exists to support the safety and efficacy of tranexamic acid, its use results in a similar reduction in transfusion during cardiac surgery (Hardy, 2001).