Con: Aprotinin has a good efficacy and safety profile relative to other alternatives for prevention of bleeding in cardiac surgery.

W. Scott Beattie, MD, PhD, FRCPC* Keyvan Karkouti, MD, MSc, FRCPC*† It is our position that, to reduce perioperative blood loss in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), all patients should receive a drug with antifibrinolytic properties (heretofore referred to as “antifibrinolytic drugs”), and that the drug of choice for this indication in most (if not all) patients should be a lysine analog (tranexamic acid or -aminocaproic acid), rather than aprotinin. This position is based on several facts which have been gleaned from all the available evidence: