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BACKGROUND:  Cardiac surgery with cardiopulmonary bypass may result in excessive fibrinolysis and platelet (PLT) dysfunction, resulting in impaired hemostasis and excessive blood loss. Prophylactic use of the antifibrinolytic drugs aprotinin and tranexamic acid is thought to prevent these hemostatic defects. Their relative clinical utility and safety in high‐transfusion‐risk cardiac surgery, however, is not known.

STUDY DESIGN AND METHODS:  Using propensity scores, 449 patients who received aprotinin for high‐transfusion‐risk cardiac surgery were matched to 449 patients who received tranexamic acid from a pool of 10,870 consecutive patients who underwent cardiac surgery at a single center, 586 of whom received aprotinin and the remainder of whom received tranexamic acid.

RESULTS:  The two matched groups were well balanced in terms of measured perioperative variables. Blood product …