Perioperative coagulation management during cardiac surgery

Abstract

Cardiac surgery patients commonly present bleeding complications that negatively influence patient's clinical outcome. Therefore, fast and detailed diagnoses as well as early and specific therapy of perioperative coagulopathy are of high clinical relevance. The so-called point-of-care (POC) methods for coagulation analyses are increasingly used in perioperative care. It is the purpose of this review to present modern aspects of coagulation management, discuss the effect of the implementation of POC methods in perioperative care, and present substantial components of hemotherapy algorithms to manage coagulopathy in cardiac surgery patients. Recent studies suggest that implementation of point-of-care testing in hemotherapy algorithms which inclose stepwise therapeutic escalation may reduce perioperative blood loss and the transfusion rate of allogenic blood products. This should improve patient's clinical outcome and reduce costs. Prospective randomized multicenter studies are needed to confirm the hypothesis that algorithm-based specific hemotherapy in conjunction with POC testing minimizes patient's exposure to blood products and improves clinical outcome.