The authors review hemostatic mechanisms and the potential harms of antifibrinolytic therapy in cardiac surgery. They discuss the thrombotic risks associated with antifibrinolytics, specially in light of the studies published since 2006. They conclude wisely that “the routine use of antifibrinolytics in a diverse cardiac surgical population may be associated with various adverse events which had not been evident from previous proof-of-efficacy trials.” Depending on baseline hemostatic conditions, inhibition of the fibrinolytic pathway may not be benign and result in thrombosis.

– Jean-Franois Hardy