[Management of hemostasis disorders after extracorporeal circulation. A clinical therapy algorithm].
After cardiac surgery with extracorporeal circulation, approximately 20% of patients show significant bleeding tendencies and 5% require re-intervention. In 50% of patients undergoing re-operation, no surgical cause can be determined, suggesting coagulopathy after cardiopulmonary bypass (CPB). For perioperative management of transfusion of blood products and coagulation factor concentrates, a clinical algorithm for the perioperative hemostatic therapy in patients undergoing cardiac surgery with CPB has been developed. The currently available evidence and the point of care methods routinely accessible in our institution (blood gas analysis, ACT, point of care Quick value, aPTT and platelet count) were used. The intervention with plasma products, coagulation factor concentrates and hemostatic drugs after extracorporeal circulation are described. Extensive bleeding history as well as the efficacy and side effects of antifibrinolytic treatment are discussed.
Jámbor
C
C
Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt a.M. jambor@med.uni-frankfurt.de
Bremerich
D
D
Moritz
A
A
Seifried
E
E
Zwissler
B
B
D000465:Algorithms; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000628:therapy*; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D001784:Blood Gas Analysis; D001803:Blood Transfusion; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D005112:Extracorporeal Circulation; D005340:Fibrinogen / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006494:Heparin Antagonists / Q000627:therapeutic use; D006801:Humans; D010314:Partial Thromboplastin Time; D010949:Plasma; D010976:Platelet Count; D019095:Point-of-Care Systems; D011183:Postoperative Complications / Q000628:therapy*
D000933:Antifibrinolytic Agents; D001779:Blood Coagulation Factors; D006494:Heparin Antagonists; D005340:Fibrinogen; D006493:Heparin; D003894:Deamino Arginine Vasopressin