Coagulation Management Strategies in Cardiac Surgery

Abstract

Postoperative hemorrhage remains a clinically important problem after major cardiac surgery. This review focuses on the current evidence and emerging data relating to modern strategies in coagulation management in bleeding patients after cardiac surgery. The use of standard laboratory coagulation tests including prothrombin time and activated partial thromboplastin time is limited by long turn-around time, and questionable sensitivity and specificity in major bleeding. Point-of-care coagulation testing including thromboelastometry and thromboelastography has been shown to reduce allogeneic blood product usage, and potentially morbidity. Perioperative coagulation therapy includes the transfusion of platelet concentrates or plasma products and the infusion of coagulation factor concentrates. However, threshold for intervention with these procoagulants are controversial, varying widely among institutions. Coagulopathy and bleeding after cardiac surgery are often multifactorial. A timely and proper hemostatic intervention guided by point-of-care coagulation testing might reduce complications secondary to hemodynamic instability, prolonged mechanical ventilation, and transfusion of large amounts of allogeneic blood products.