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Post cardiopulmonary bypass bleeding: an introductory review
1Jack D. Weiler Hospital of the Albert Einstein College of Medicine, Bronx, New York, USA.
Insights
Postoperative bleeding is a significant risk following cardiac surgery with cardiopulmonary bypass (CPB). This review covers hemostasis defects, monitoring, and management strategies to reduce bleeding complications.
Area of Science:
- Cardiology
- Hematology
- Anesthesiology
Background:
- Cardiac surgery utilizing cardiopulmonary bypass (CPB) has advanced significantly in safety and volume over 40 years.
- Postoperative bleeding remains a critical source of perioperative morbidity, with reported incidences ranging from 4% to 32%.
Purpose of the Study:
- To review preoperative evaluations for hemostasis defects in patients undergoing cardiac surgery.
- To discuss coagulation alterations associated with extracorporeal circulation and CPB.
- To outline monitoring, management, and therapeutic strategies for post-CPB bleeding.
Main Methods:
- Literature review of preoperative evaluation and hemostasis defects.
- Discussion of coagulation monitoring during and after cardiac surgery.
- Analysis of methods to mitigate coagulation system alterations.
- Review of therapeutic interventions and risks for post-CPB bleeding.
Main Results:
- Preoperative assessment and identification of specific hemostasis defects are crucial.
- Extracorporeal circulation can induce significant alterations in the coagulation system.
- Effective monitoring and timely intervention are key to managing bleeding risks.
Conclusions:
- Optimizing hemostasis management is essential for reducing morbidity after cardiac surgery.
- Understanding and addressing coagulation defects associated with CPB can improve patient outcomes.
- Comprehensive strategies for monitoring and treating post-CPB bleeding are necessary.
Abstract:
Cardiac surgery requiring cardiopulmonary bypass (CPB) has increased in both number and safety over the past four decades. Postoperative bleeding continues to be a major cause of perioperative morbidity. The reported incidence varies from 4-32%. This paper reviews the preoperative evaluation and specific hemostasis defects associated with cardiac surgery and extracorporeal circulation. Monitoring of anticoagulation and coagulation, methods to decrease the alterations of the coagulation system, as well as the specific therapy for and risks of post-CPB bleeding are also discussed.