[Indications and contraindications for protease inhibitors].

Clinical interest in protease inhibitors was maximal at a time when it was believed that acute bleeding tendency in some situations was due to "primary hyperfibrinolysis". Progress in diagnostic procedures resulted in better knowledg of the true nature of such dramatic hemorrhagic diatheses, which are due in fact to disseminated intravascular clotting with "consumption coagulopathy", a situation in which proteolytic inhibitors are contraindicated. Other indications have been thoroughly investigated by controlled trials, e.g. essential hypermenorrhea and postoperative hematuria after prostatectomy. Likewise, a significant protective effect of aprotinin in acute pancreatitis has been recently demonstrated. Finally, congenital deficiencies of natural inhibitors such as alpha1-antitrypsin and C1-esterase-inhibitor may benefit from substitutive therapy with exogenous or synthetic inhibitors.