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Published on: March 23, 2018
Coagulation disorders of cardiopulmonary bypass: a review
Domenico Paparella1, Stephanie J Brister, Michael R Buchanan
1Division of Cardiac Surgery, Dipartimento di Emergenza e Trapianti di Organo, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy. paparella@tin.it
Insights
Postoperative bleeding after cardiac surgery is common. Adjusting heparin and protamine based on heparin levels, rather than fixed doses, may reduce bleeding and coagulopathy.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Anesthesiology
Background:
- Postoperative bleeding is a frequent complication following cardiac surgery.
- Several factors contribute to bleeding, including surgical trauma and cardiopulmonary bypass (CPB).
Purpose of the Study:
- To explore the mechanisms behind coagulopathy and bleeding after cardiac surgery.
- To identify strategies for mitigating postoperative blood loss.
Main Methods:
- Review of factors contributing to coagulopathy during CPB.
- Analysis of platelet activation and dysfunction.
- Evaluation of heparin and protamine administration strategies.
Main Results:
- CPB, heparin, hypothermia, and protamine influence coagulation and platelet function.
- Inadequate protamine administration exacerbates platelet dysfunction.
- Dosing heparin and protamine based on heparin concentrations may decrease coagulopathy and bleeding.
Conclusions:
- Understanding the complex interplay of coagulation, inflammation, and fibrinolysis during CPB is crucial.
- Optimizing technical and pharmaceutical interventions can improve patient outcomes and reduce blood loss.
Background:
Postoperative bleeding is one of the most common complications of cardiac surgery.
Discussion:
Extensive surgical trauma, prolonged blood contact with the artificial surface of the cardiopulmonary bypass (CPB) circuit, high doses of heparin, and hypothermia are all possible triggers of a coagulopathy leading to excessive bleeding. Platelet activation and dysfunction also occur and are caused mainly by heparin, hypothermia, and inadequate protamine administration. Heparin and protamine administration based on heparin concentrations as opposed to fixed doses may reduce coagulopathy and postoperative blood loss.
Conclusions:
A better comprehension of the multifactorial mechanisms of activation of coagulation, inflammation, and fibrinolytic pathways during CPB may enable a more effective use of the technical and pharmaceutical options which are currently available.
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