Blood products usage in cardiac surgery.
Many patients undergo cardiac surgery with preexisting congenital and acquired coagulation defects. Almost all of these can be recognized and corrected preoperatively. In a complex operation involving the use of cardiopulmonary bypass (CPB), the significance of isolated changes in coagulation tests is difficult to assess. Many variable must be taken into consideration, including the coagulation and fibrinolytic systems, their natural inhibitors, and platelet number and function. CPB induces a variety of abnormalities of coagulation. These abnormalities do not always cause clinically significant bleeding. When they do, laboratory assessment and blood-component usage can usually correct the defect. The use of blood products is associated with allergic, viral, and hemolytic risks. Exciting advances have been made in the use of pharmacologic alternatives to blood products. Both Desmopressin (DDAVP) and aprotinin seem promising in this respect, but more investigation is needed on specific indications for these drugs and on the possible problems with a drug-induced thrombotic tendency. In the future, anesthesiologists and surgeons may look forward to more safe and effective therapy of bleeding in cardiac surgical patients.
Dellora
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C
Department of Chemical and Clinical Research, Ospedale Maggiore of Novara, Italy.
Minola
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P
Parodi
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F
De Gasperis
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C
D016913:Blood Component Transfusion; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001810:Blood Volume; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma; D010976:Platelet Count; D013997:Time Factors
D006454:Hemoglobins