Cardiopulmonary bypass in patients with pre-existing coagulopathy.
Patients with pre-existing coagulopathies who undergo surgical interventions are at increased risk for bleeding complications. This risk is especially true in cardiac surgical procedures with cardiopulmonary bypass (CPB) because of the necessity for heparinization and the use of the extracorporeal circuits, which have destructive effects on most of the blood components. In this review, cases of cardiac surgeries in patients with certain pre-existing coagulopathies are summarized, which could shed a light on future managements of such patients undergoing cardiac procedures with CPB. Pre-existing coagulopathies include antithrombin III deficiency, heparin-induced thrombocytopenia, cancer, factor XII deficiency, hemophilia, idiopathic thrombocytopenic purpura, protein S deficiency, and drug-induced platelet inhibition. In summary, pre-existing coagulopathy in patients undergoing open-heart surgeries, if not recognized and appropriately managed, can cause serious complications. Management of patients undergoing cardiac procedures should include a routine coagulation work-up and a thorough past medical history examination. If any of the foregoing is abnormal, further evaluation is warranted. Proper diagnosis and management of the pre-existing coagulopathy disorders is of crucial importance to the surgical outcome and long-term morbidity.
DeBois
William
W
New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York 10021, USA. wdebois@nyp.org
Liu
Junli
J
Lee
Leonard
L
Girardi
Leonard
L
Ko
Wilson
W
Tortolani
Anthony
A
Krieger
Karl
K
Isom
O Wayne
OW
D001778:Blood Coagulation Disorders / Q000150:complications* / Q000175:diagnosis*; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008487:Medical History Taking; D009369:Neoplasms / Q000150:complications / Q000601:surgery; D012307:Risk Factors; D013921:Thrombocytopenia / Q000139:chemically induced / Q000150:complications
D006493:Heparin