Coagulation-Friendly Environment in Cardiac Surgery: A Narrative Review

Area of Science:

• Anesthesiology and Critical Care Medicine
• Hematology
• Surgical Sciences

Background:

• Perioperative bleeding is a significant complication in cardiac surgery, increasing morbidity, mortality, and transfusion needs.
• Current patient blood management and hemostatic therapies have limitations.
• The impact of fundamental physiological factors on coagulation is not fully understood.

Purpose of the Study:

• To review the effects of acidosis, hypothermia, hypocalcemia, and anemia on hemostasis.
• To propose the concept of a coagulation-friendly environment for managing bleeding in cardiac surgery.

Main Methods:

• Comprehensive narrative review of in vitro and in vivo studies.
• Assessment of the impact of key physiological variables on coagulation.
• Synthesis of evidence regarding hemostatic interventions.

Main Results:

• Acidosis, hypothermia, hypocalcemia, and anemia negatively affect hemostasis.
• These factors can modulate coagulation and reduce the efficacy of hemostatic treatments.
• A coagulation-friendly environment is essential for effective bleeding control.

Conclusions:

• Optimizing acid-base balance, temperature, calcium levels, and hematocrit is fundamental for hemostasis.
• Integrating these optimizations into patient blood management can improve bleeding outcomes.
• Effective hemostatic therapy requires a supportive physiological milieu.