title: Coagulopathy and hemostatic monitoring in cardiac surgery: an update.
abstract: OBJECTIVE
  Cardiac surgery with cardiopulmonary bypass (CPB) causes severe derangements in the hemostatic system, which in turn puts the patient at risks of microvascular bleeding. Excessive transfusion and surgical re-exploration after cardiac surgery are potentially associated with a number of adverse outcomes including increased mortality.
  
  
  METHODS
  This review describes coagulopathies occurring in cardiac surgery and the monitoring of these. Viscoelastic hemostatic assays (VHA) have routinely been used in cardiac surgery for more than 25 years and at least 16 studies (involving more than 3250 patients, including three randomized controlled trials) have compared VHA to routine coagulation tests (RCoT) with regards to their ability to predict bleeding and re-do surgery and also with regards to transfusion requirements secondary to hemostatic therapy based on VHA vs. RCoT.
  
  
  RESULTS
  All 16 studies demonstrated superiority with VHA as compared to RCoT both in predicting bleeding and need for re-do surgery and in reducing the total amount of blood transfusions by employing goal-directed administration of blood products based on VHA as compared RCoT based therapy or at the clinicians discretion.
  
  
  CONCLUSIONS
  The different types of coagulopathies observed in patients undergoing cardiac surgery requires adequate and timely hemostatic therapy and real-time monitoring with WHA such as TEG/ROTEM and whole blood platelet aggregometry.
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen, Denmark. per.johansson@rh.regionh.dk
authors.forename: Pär I
authors.initials: PI
authors.lastname: Johansson
authors.forename: Sacha
authors.initials: S
authors.lastname: Sølbeck
authors.forename: Gustav
authors.initials: G
authors.lastname: Genet
authors.forename: Jakob
authors.initials: J
authors.lastname: Stensballe
authors.forename: Sisse R
authors.initials: SR
authors.lastname: Ostrowski
mesh_terms: D000138:Acidosis; D000925:Anticoagulants / Q000008:administration & dosage; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006487:Hemostasis; D006489:Hemostatic Techniques; D006801:Humans; D007036:Hypothermia, Induced; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D012306:Risk
chemical_list: D000925:Anticoagulants