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Methods for monitoring hemostasis during and following cardiac surgery
1Division of Clinical Perfusion Education, University of Nebraska Medical Center, Omaha, USA.
The challenges in cardiac surgical hemostasis continue to plague the clinician. Rapid analysis and interpretation of coagulation tests are crucial in identifying coagulopathies that include both hemorrhagic and thrombophilic conditions. An understanding of the hemostatic mechanism, combined with a knowledge of pharmaceutical and transfusion interventions, is necessary to develop effective therapeutic plans. The coagulation tests that provide the most useful information include both end-point determinants and kinetic tests of clot formation. Future evaluation of the efficacy of coagulation tests in meeting these challenges will move beyond quantification of changes within various intermediates of hemostasis and rest with the correlation of these measured values with specific, outcome-directed indicators for optimizing patient care.
The challenges in cardiac surgical hemostasis continue to plague the clinician. Rapid analysis and interpretation of coagulation tests are crucial in identifying coagulopathies that include both hemorrhagic and thrombophilic conditions. An understanding of the hemostatic mechanism, combined with a knowledge of pharmaceutical and transfusion interventions, is necessary to develop effective therapeutic plans. The coagulation tests that provide the most useful information include both end-point determinants and kinetic tests of clot formation. Future evaluation of the efficacy of coagulation tests in meeting these challenges will move beyond quantification of changes within various intermediates of hemostasis and rest with the correlation of these measured values with specific, outcome-directed indicators for optimizing patient care.