Comprehensive Coagulation Management in Cardiac Surgery: Anticoagulants, Heparin Resistance, Monitoring, and Bleeding...

Area of Science:

• Cardiovascular Surgery
• Hematology
• Anesthesiology

Background:

• Coagulation management is critical for cardiac surgery outcomes.
• Bleeding and transfusion needs significantly impact patient safety.
• Current strategies face limitations in managing complex coagulopathies.

Purpose of the Study:

• To review current coagulation management strategies in cardiac surgery.
• To examine limitations of existing methods and explore emerging innovations.
• To highlight advancements in anticoagulation, monitoring, and bleeding control.

Main Methods:

• Comprehensive literature review of coagulation management in cardiac surgery.
• Analysis of current anticoagulants (e.g., unfractionated heparin) and alternatives.
• Evaluation of coagulation monitoring techniques (ACT, anti-Xa, TEG/ROTEM).

Main Results:

• Unfractionated heparin is standard for CPB, but resistance is a challenge.
• Viscoelastic tests and other assays guide perioperative therapy.
• Bleeding persists due to pre-op antithrombotics, CPB effects, and hemostatic deficits.

Conclusions:

• Management involves antifibrinolytics, transfusion protocols, and reversal agents.
• Emerging innovations include AI, targeted antithrombotics, and gene therapy.
• Further research is needed to validate new therapies and refine protocols.