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Blood-product usage in cardiac surgery
1Mount Sinai Medical Center, New York, NY 10029-6574.
Insights
Cardiac surgery patients often have coagulation defects, manageable preoperatively. Cardiopulmonary bypass (CPB) can cause bleeding issues, but logical assessment and blood products, or newer synthetic alternatives, can correct them, improving patient safety.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Anesthesiology
Background:
- Patients undergoing cardiac surgery frequently present with pre-existing congenital or acquired coagulation disorders.
- Cardiopulmonary bypass (CPB) is known to induce coagulopathies affecting plasma proteins, platelets, and fibrinolysis.
- These CPB-induced abnormalities may not always lead to clinically significant bleeding.
Purpose of the Study:
- To review the management of coagulation defects in cardiac surgery patients.
- To discuss the hemostatic challenges induced by cardiopulmonary bypass.
- To explore current and future therapeutic strategies for bleeding in this population.
Main Methods:
- Literature review of coagulation abnormalities in cardiac surgery.
- Analysis of laboratory assessment and blood-component usage for bleeding management.
- Evaluation of synthetic alternatives and pharmacologic agents like DDAVP and aprotinin.
Main Results:
- Preoperative identification and correction of coagulation defects are crucial.
- CPB-induced coagulopathies can typically be managed with appropriate laboratory assessment and blood products.
- Blood product transfusion carries inherent risks, driving interest in synthetic alternatives.
Conclusions:
- While CPB-induced bleeding can usually be managed, risks associated with blood products necessitate safer alternatives.
- DDAVP and aprotinin show promise but require further investigation regarding efficacy and thrombotic risks.
- Future advancements aim for safer and more effective bleeding therapies in cardiac surgical patients.
Abstract:
Many patients undergo cardiac surgery with preexisting congenital and acquired coagulation defects. Almost all of these can be recognized and corrected preoperatively. CPB itself induces a variety of abnormalities of coagulation, affecting plasma proteins, platelets, and the fibrinolytic system. These abnormalities do not always cause clinically significant bleeding. When they do, logical laboratory assessment and blood-component usage can usually correct the defect. The use of blood products is associated with allergic, viral, and hemolytic risks. Exciting advances have been made in the use of synthetic alternatives to blood products. Both DDAVP and aprotinin seem promising in this respect, but more investigation is needed into the mechanisms of action and possible thrombotic complications of these drugs. In the future, anesthesiologists and surgeons may look forward to more safe and effective therapy of bleeding in cardiac surgical patients.