title: Coagulation considerations for infants and children undergoing cardiopulmonary bypass.
abstract: Cardiac surgery involving cardiopulmonary bypass imposes a significant pathophysiologic burden on patients. Pediatric patients are especially predisposed to the adverse effects of surgery and bypass on the coagulation system, with resultant bleeding, transfusion, and poor outcomes. These risks accrue to pediatric patients in inverse proportion to their weight and are attributable to hematologic immaturity, coagulation defects associated with congenital heart disease, bypass equipment, and the nature of congenital heart surgery. Standard anticoagulation does not completely inhibit thrombin generation, and continuous consumption of coagulation factor continues throughout bypass. Conventional measurements of anticoagulation during bypass poorly reflect this incomplete anticoagulation, and alternate methods may improve anticoagulant therapy. Emerging therapies for blocking the effects of bypass on the coagulation system hold promise for decreasing bleeding and related complications, and improving outcomes in congenital heart surgery.
authors.affiliation: Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. Michael_Eaton@urmc.rochester.edu
authors.forename: Michael P
authors.initials: MP
authors.lastname: Eaton
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Iannoli
mesh_terms: D000293:Adolescent; D000375:Aging / Q000502:physiology; D000758:Anesthesia; D000925:Anticoagulants / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001777:Blood Coagulation / Q000502:physiology*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015942:Factor VIIa / Q000627:therapeutic use; D006330:Heart Defects, Congenital / Q000601:surgery; D006487:Hemostasis; D006801:Humans; D007223:Infant; D007260:Infusion Pumps; D007431:Intraoperative Complications / Q000097:blood; D010347:Patient Care Planning; D019990:Perioperative Care; D019106:Postoperative Hemorrhage / Q000628:therapy
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D015942:Factor VIIa