Anticoagulation and hemostasis in cardiac surgical patients.
Optimizing anticoagulation and hemostasis during cardiopulmonary bypass and perioperatively helps to ensure the best possible clinical outcome. This article reviews the pharmacology of unfractionated and low-molecular weight heparin, aprotinin, desmopressin, dextran, antiplatelet agents, warfarin, and direct thrombin inhibitors. Their use is discussed in the context of coronary artery surgery, valvular surgery, and mechanical cardiac support devices, as well as in the management of acute ischemic syndromes, atrial fibrillation, and prevention and treatment of venous thromboembolism. Progress in the development and utilization of these anticoagulants and antiplatelet agents has supported the major advances that have been achieved in cardiac surgery.
Kondo
N I
NI
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
Maddi
R
R
Ewenstein
B M
BM
Goldhaber
S Z
SZ
D000925:Anticoagulants / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D002318:Cardiovascular Diseases / Q000097:blood / Q000601:surgery; D006488:Hemostasis, Surgical / Q000379:methods*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011479:Protamines / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D011479:Protamines; D014859:Warfarin; D006493:Heparin