Key messages

• Aprotinin is a naturally occurring non-specific serine protease inhibitor.

• The major role of aprotinin in critical care practice is the prevention of bleeding associated with extracorporeal circulations.

• Life-threatening bleeding due to thrombolytic therapy may be arrested by the plasmin inactivation effect of low-dose aprotinin.

• In septic shock and hepatic cirrhosis, high-dose aprotinin may improve hypotension and organ perfusion.

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