Hemotherapy algorithms for coagulopathic cardiac surgery patients

In patients undergoing cardiac surgery, perioperative coagulopathy and the use of allogenic blood products are independently associated with increased mortality and major perioperative cardiac and non-cardiac adverse events. Hemotherapy should be based on specific hemotherapy algorithms rather than "clinical judgments". However, whether hemotherapy should be based on "classical" conventional laboratory coagulation analyses or Point-of-Care (POC) measures is discussed controversially. There is very good evidence from retrospective studies and prospective randomized controlled trials that the implementation of viscoelastic and aggregometric measurements in hemostatic therapy algorithms may reduce the transfusion rate of allogenic blood products. Furthermore, data suggest improved clinical outcome. Unfortunately, the studied hemotherapy--algorithms are very complex and thus hard to integrate into daily practice. In close cooperation of three German University Hospitals, the authors developed and implemented two more comprehensive and practical hemotherapy algorithms that are based on either POC measures or conventional coagulation testing. Here we present and discuss the structure and limitations of these algorithms.