Coagulation disorders of cardiopulmonary bypass: a review.
BACKGROUND
Postoperative bleeding is one of the most common complications of cardiac surgery.


CONCLUSIONS
Extensive surgical trauma, prolonged blood contact with the artificial surface of the cardiopulmonary bypass (CPB) circuit, high doses of heparin, and hypothermia are all possible triggers of a coagulopathy leading to excessive bleeding. Platelet activation and dysfunction also occur and are caused mainly by heparin, hypothermia, and inadequate protamine administration. Heparin and protamine administration based on heparin concentrations as opposed to fixed doses may reduce coagulopathy and postoperative blood loss.


CONCLUSIONS
A better comprehension of the multifactorial mechanisms of activation of coagulation, inflammation, and fibrinolytic pathways during CPB may enable a more effective use of the technical and pharmaceutical options which are currently available.
Paparella
Domenico
D
Division of Cardiac Surgery, Dipartimento di Emergenza e Trapianti di Organo, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy. paparella@tin.it
Brister
Stephanie J
SJ
Buchanan
Michael R
MR
D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D005342:Fibrinolysis / Q000187:drug effects; D006487:Hemostasis / Q000187:drug effects* / Q000502:physiology; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007249:Inflammation / Q000378:metabolism / Q000503:physiopathology; D010974:Platelet Aggregation / Q000187:drug effects; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors
D000925:Anticoagulants; D006493:Heparin