Abstract
A NUMBER OF FACTORS can complicate the management of perioperative coagulation. Preexisting patient factors, including the presence of mechanical prosthetic valves, chronic therapeutic anticoagulation, and a history of heparin-induced thrombocytopenia (HIT) require evaluation and preparation before surgery and may require alterations to standard intraoperative management (eg, bridging of anticoagulation, the use of unfractionated heparin, etc). Factors related to surgery that add complexity to the demands of coagulation management include the presence of congenital heart disease with multiple prior sternotomies that make the reentry sternotomy high risk, aortic pathology that requires hypothermic circulatory arrest for successful surgical repair, and prolonged cardiopulmonary bypass time. The authors present for discussion a complex case involving all of these elements.
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