Antifibrinolytiske

Antifibrinolytics (antifibrinolytiske in Danish) are drugs that slow or stop the breakdown of blood clots by inhibiting fibrinolysis. They preserve formed clots to reduce or prevent excessive bleeding and are used in a range of clinical settings. They are distinct from anticoagulants, which primarily prevent new clot formation.

The primary mechanism involves disrupting the activity of plasmin, the enzyme that degrades fibrin. Most antifibrinolytics are lysine analogs that block plasminogen from binding to fibrin, preventing its activation to plasmin. The main agents are tranexamic acid and aminocaproic acid. Aprotinin, a broader protease inhibitor formerly used to suppress plasmin activity, is now rarely employed due to safety concerns.

Common uses include reducing perioperative blood loss during surgery, controlling dental and mucosal bleeding in at-risk patients, and treating heavy menstrual bleeding or other mucosal bleeding in certain bleeding disorders. They can be given systemically (oral or intravenous) or locally (for example, tranexamic acid mouthwash or topical applications) depending on the clinical situation.

Safety considerations include a risk of thromboembolic events, particularly in patients with a history of thrombosis or active thrombotic disease. They can cause renal impairment in some patients and, at high intravenous doses, may be associated with seizures. Hypersensitivity reactions can occur, and use should be guided by clinical indication and renal function, with monitoring for adverse effects.