title: Perioperative Coagulation Management of a Hemophilia A Patient During Cardiac Surgery.
abstract: Perioperative management of cardiovascular surgical procedures requiring cardiopulmonary bypass (CPB) in patients with hemophilia A poses a clinical challenge in coagulation management. Use of CPB requires the administration of an anticoagulant, usually unfractionated heparin, and also causes dilutional coagulopathy, platelet dysfunction or platelet consumption coagulopathy. Hypothermia and activation of the inflammatory cascade also affect coagulation. The effects of CPB on circulating levels of factor VIII have not been clearly defined. In this review, the effects of CPB and hemodilution on FVIII are shown in a case presentation, and perioperative laboratory testing in patients with hemophilia A having cardiac surgery is discussed along with perioperative and postoperative coagulation management.
authors.affiliation: 1 University of Maryland Medical System, Baltimore, MD, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Odonkor
authors.affiliation: 1 University of Maryland Medical System, Baltimore, MD, USA.
authors.forename: Archana
authors.initials: A
authors.lastname: Srinivas
authors.affiliation: 1 University of Maryland Medical System, Baltimore, MD, USA.
authors.forename: Erik
authors.initials: E
authors.lastname: Strauss
authors.affiliation: 1 University of Maryland Medical System, Baltimore, MD, USA.
authors.forename: Brittney
authors.initials: B
authors.lastname: Williams
authors.affiliation: 1 University of Maryland Medical System, Baltimore, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Mazzeffi
authors.affiliation: 1 University of Maryland Medical System, Baltimore, MD, USA.
authors.forename: Kenichi A
authors.initials: KA
authors.lastname: Tanaka
mesh_terms: D015119:Aminocaproic Acid / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods*; D005169:Factor VIII / Q000187:drug effects; D006438:Hemodilution / Q000379:methods; D006467:Hemophilia A / Q000150:complications*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011479:Protamines / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D011479:Protamines; D005169:Factor VIII; D006493:Heparin; D015119:Aminocaproic Acid
keywords: cardiac surgery; cardiopulmonary bypass; coagulation monitoring; factor VIII; hemodilution; hemophilia A