Recognition and management of bleeding following cardiac surgery

The major hemorrhagic disorders are associated with malfunction of three physiologic systems either separately or in combination: (1) abnormalities of platelets, (2) abnormalities of blood vessels, and (3) abnormalities of plasma coagulation factors. Platelets contribute to hemostasis not only by participating physically by occluding rents and tears in small vessel but also by involving the coagulation process through their biochemical activities. It is small wonder that platelet dysfunction is the most common cause of nonsurgical bleeding following CPB; however, the potential for hyperfibrinolysis cannot be overlooked. New laboratory tests and therapeutic approaches have allowed for more accurate diagnosis and more appropriate therapy in a variety of bleeding events following CPB.