aprotinin + epsilon aminocaproic acid

Aprotinin and epsilon aminocaproic acid are antifibrinolytic agents used in combination to reduce postoperative blood loss after cardiopulmonary bypass. This combination has been studied particularly in infants with congenital cyanotic heart disease undergoing corrective surgical procedures. Studies have shown that the combination may be slightly more effective than either agent alone in reducing blood loss and transfusion requirements. Aprotinin is a serine protease inhibitor that inhibits multiple mediators including kallikrein and plasmin, while epsilon aminocaproic acid binds to plasminogen and blocks its activation to plasmin, thereby reducing fibrinolysis.