Mortality manifesto: a meta-analysis of aprotinin and tranexamic acid mortality.

Later and colleagues presented the results from a non-sponsored, double-blind, randomised trial comparing the clinical outcomes for tranexamic acid and aprotinin [1]. They report that aprotinin significantly reduced bleeding in comparison with tranexamic acid, but there was no difference in the number of packed red blood cells. With regard to outcomes, they report no significant differences, but negate the twofold difference in mortality. This issue of comparative mortality with anti-fibrinolytic agents has been unresolved as yet. For this reason, we updated our head-to-head meta-analysis to determine the safety of aprotinin over tranexamic acid with regard to mortality.