PLG and heart failure: TXA has no effect on activated plasmin and its moderate affinity requires the use of relatively high TXA concentrations, which can lead to seizures, probably caused by a nonspecific binding to the GABAA and glycine receptors.[3, 4] Numerous side effects, like an increased risk of myocardial infarction, heart failure, stroke, or encephalopathy have been reported for the use of the direct plasmin inhibitor aprotinin in cardiac surgery.[5, 6] As a consequence, aprotinin is no longer used in the United States to reduce perioperative bleeding.