Evidence based coagulation monitors: heparin monitoring, thromboelastography, and platelet function

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Hematology

Background:

• Cardiac surgery patients undergoing cardiopulmonary bypass (CPB) face unique hemostatic challenges.
• CPB requires careful anticoagulation management, while post-CPB hemostasis is often compromised by antiplatelet medications, leading to bleeding.
• Cardiac surgical patients account for a disproportionate number of perioperative blood transfusions.

Purpose of the Study:

• To review the evidence supporting the use of point-of-care (POC) monitors in coagulation and hemostasis management for cardiac surgical patients.
• To discuss advances in anticoagulation and monitoring techniques for CPB.
• To highlight the need for a multimodal approach to blood conservation and hemostasis monitoring.

Main Methods:

• Review of current literature on anticoagulation, hemostasis, and POC monitoring in cardiac surgery.
• Discussion of the interplay between anticoagulation and hemostasis during CPB.
• Analysis of different POC hemostasis monitoring technologies and their applications.

Main Results:

• CPB-induced hemostatic defects are multifactorial, necessitating comprehensive management.
• POC hemostasis monitoring offers potential for improved patient outcomes and blood conservation.
• Various POC technologies exist, each with specific attributes for different patient populations and expected defects.

Conclusions:

• Optimal anticoagulation and hemostasis monitoring are critical during CPB.
• A multimodal strategy, including heparin management and POC monitoring, is essential for blood conservation.
• POC monitors are valuable tools for managing coagulation and hemostasis in cardiac surgery.