Domenico Paparella1, Stephanie J Brister, Michael R Buchanan. 1. Division of Cardiac Surgery, Dipartimento di Emergenza e Trapianti di Organo, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy. paparella@tin.it
Abstract
BACKGROUND: Postoperative bleeding is one of the most common complications of cardiac surgery. DISCUSSION: Extensive surgical trauma, prolonged blood contact with the artificial surface of the cardiopulmonary bypass (CPB) circuit, high doses of heparin, and hypothermia are all possible triggers of a coagulopathy leading to excessive bleeding. Platelet activation and dysfunction also occur and are caused mainly by heparin, hypothermia, and inadequate protamine administration. Heparin and protamine administration based on heparin concentrations as opposed to fixed doses may reduce coagulopathy and postoperative blood loss. CONCLUSIONS: A better comprehension of the multifactorial mechanisms of activation of coagulation, inflammation, and fibrinolytic pathways during CPB may enable a more effective use of the technical and pharmaceutical options which are currently available.
BACKGROUND:Postoperative bleeding is one of the most common complications of cardiac surgery. DISCUSSION: Extensive surgical trauma, prolonged blood contact with the artificial surface of the cardiopulmonary bypass (CPB) circuit, high doses of heparin, and hypothermia are all possible triggers of a coagulopathy leading to excessive bleeding. Platelet activation and dysfunction also occur and are caused mainly by heparin, hypothermia, and inadequate protamine administration. Heparin and protamine administration based on heparin concentrations as opposed to fixed doses may reduce coagulopathy and postoperative blood loss. CONCLUSIONS: A better comprehension of the multifactorial mechanisms of activation of coagulation, inflammation, and fibrinolytic pathways during CPB may enable a more effective use of the technical and pharmaceutical options which are currently available.
Authors: Gabriel S Aldea; Louise O Soltow; Wayne L Chandler; Christopher M Triggs; Craig R Vocelka; Gregory I Crockett; Yong T Shin; William E Curtis; Edward D Verrier Journal: J Thorac Cardiovasc Surg Date: 2002-04 Impact factor: 5.209
Authors: T Kojima; S Gando; O Kemmotsu; H Mashio; Y Goda; H Kawahigashi; N Watanabe Journal: J Cardiothorac Vasc Anesth Date: 2001-02 Impact factor: 2.628
Authors: H te Velthuis; C Baufreton; P G Jansen; C M Thijs; C E Hack; A Sturk; C R Wildevuur; D Y Loisance Journal: J Thorac Cardiovasc Surg Date: 1997-07 Impact factor: 5.209
Authors: Alice Wiefferink; Patrick W Weerwind; Waander van Heerde; Steven Teerenstra; Luc Noyez; Ben E de Pauw; René M H J Brouwer Journal: J Extra Corpor Technol Date: 2007-06
Authors: Kevin Fleming; Roberta E Redfern; Rebekah L March; Nathan Bobulski; Michael Kuehne; John T Chen; Michael Moront Journal: J Extra Corpor Technol Date: 2017-12
Authors: P Gueret; S Combe; C Krezel; E Fuseau; P L M van Giersbergen; M Petitou; E Neuhart Journal: Eur J Clin Pharmacol Date: 2016-10-15 Impact factor: 2.953
Authors: Jacob T Beyer; Kelly E Schoeppler; Giorgio Zanotti; Gregory M Weiss; Scott W Mueller; Robert MacLaren; Douglas N Fish; Tyree H Kiser Journal: Clin Appl Thromb Hemost Date: 2016-09-13 Impact factor: 2.389