Hemostatic and thrombotic issues in cardiac surgery

Area of Science:

• Cardiovascular Surgery
• Hemostasis and Thrombosis
• Anesthesiology

Background:

• Cardiopulmonary bypass during cardiac surgery significantly disrupts the hemostatic system.
• This disruption leads to multifactorial bleeding and thrombotic complications.
• Accurate diagnosis of bleeding causes is crucial to avoid empirical treatments.

Purpose of the Study:

• To outline the primary mechanisms of post-cardiac surgery bleeding.
• To emphasize the role of diagnostic tools in managing coagulopathy.
• To discuss strategies for preventing thromboembolic complications.

Main Methods:

• Review of seven fundamental mechanisms of post-cardiac surgery bleeding.
• Evaluation of point-of-care coagulation tests, including viscoelastic and platelet function tests.
• Discussion of underlying mechanisms for thromboembolic complications.

Main Results:

• Bleeding can result from residual heparin, reduced thrombin generation, fibrinogen deficiency, thrombocytopenia, platelet dysfunction, hyperfibrinolysis, or surgical issues.
• Viscoelastic tests aid in diagnosing bleeding mechanisms; platelet function tests assist in preoperative assessment.
• Thromboembolic risks are linked to anticoagulant consumption and endothelial damage.

Conclusions:

• Understanding the specific cause of bleeding is essential for effective clinical management.
• Point-of-care testing provides valuable guidance for complex coagulopathies.
• Further research is needed on preventing thromboembolic events and managing antithrombin levels.