A Snapshot of Coagulopathy After Cardiopulmonary Bypass.
Cardiac surgery involving cardiopulmonary bypass (CPB) is often associated with important blood loss, allogeneic blood product usage, morbidity, and mortality. Coagulopathy during CPB is complex, and the current lack of uniformity for triggers and hemostatic agents has led to a wide variability in bleeding treatment. The aim of this review is to provide a simplified picture of the data available on patients' coagulation status at the end of CPB in order to provide relevant information for the development of tailored transfusion algorithms. A nonsystematic literature review was carried out to identify changes in coagulation parameters during CPB. Both prothrombin time and activated partial thromboplastin time increased during CPB, by a median of 33.3% and 17.9%, respectively. However, there was marked variability across the published studies, indicating these tests may be unreliable for guiding hemostatic therapy. Some thrombin generation (TG) parameters were affected, as indicated by a median increase in TG lag time of 55.0%, a decrease in TG peak of 17.5%, and only a slight decrease in endogenous thrombin potential of 7%. The most affected parameters were fibrinogen levels and platelet count/function. Both plasma fibrinogen concentration and FIBTEM maximum clot firmness decreased during CPB (median change of 36.4% and 33.3%, respectively) as did platelet count (44.5%) and platelet component (34.2%). This review provides initial information regarding changes in coagulation parameters during CPB but highlights the variability in the reported results. Further studies are warranted to guide physicians on the parameters most appropriate to guide hemostatic therapy.
Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
Judith
J
Höfer
Department of Surgical and General Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria dietmar.fries@tirol-kliniken.at.
Dietmar
D
Fries
Department of Anesthesiology, Perioperative Care and General Intensive Care, Paracelsus Medical University, Salzburg University Hospital, Salzburg, Austria Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and AUVA Research Centre, Vienna, Austria CSL Behring, Marburg, Germany.
Cristina
C
Solomon
Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
Corinna
C
Velik-Salchner
Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
Julia
J
Ausserer
D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D005340:Fibrinogen; D006801:Humans; D010976:Platelet Count; D013917:Thrombin
D005340:Fibrinogen; D013917:Thrombin
bleeding; blood coagulation factors; cardiology; hemostasis; vascular and endovascular surgery