Book contents
- Cardiopulmonary Bypass
- Cardiopulmonary Bypass
- Copyright page
- Contents
- Contributors
- Foreword
- Chapter 1 Human Factors and Teamwork in Cardiac Surgery
- Chapter 2 Equipment for Cardiopulmonary Bypass
- Chapter 3 Monitoring during Cardiopulmonary Bypass
- Chapter 4 Cardiopulmonary Bypass Circuit Setup and Safety Checks
- Chapter 5 Priming Solutions for Cardiopulmonary Bypass Circuits
- Chapter 6 Anticoagulation for Cardiopulmonary Bypass
- Chapter 7 Conduct of Cardiopulmonary Bypass
- Chapter 8 Minimal Invasive Extracorporeal Circulation
- Chapter 9 Considerations for Operations Involving Deep Hypothermic Circulatory Arrest
- Chapter 10 Metabolic Management during Cardiopulmonary Bypass
- Chapter 11 Myocardial Preservation during Cardiopulmonary Bypass
- Chapter 12 Weaning from Cardiopulmonary Bypass
- Chapter 13 Intraoperative Mechanical Circulatory Support and Other Uses of Cardiopulmonary Bypass
- Chapter 14 Mechanical Circulatory Support
- Chapter 15 Cardiopulmonary Bypass for Pediatric Cardiac Surgery
- Chapter 16 Coagulopathy and Hematological Disorders Associated with Cardiopulmonary Bypass
- Chapter 17 Inflammation and Organ Damage during Cardiopulmonary Bypass
- Chapter 18 Neuromonitoring and Cerebral Morbidity Associated with Cardiopulmonary Bypass
- Chapter 19 Renal Morbidity Associated with Cardiopulmonary Bypass
- Chapter 20 Common and Uncommon Disasters during Cardiopulmonary Bypass
- Index
- References
Chapter 6 - Anticoagulation for Cardiopulmonary Bypass
Published online by Cambridge University Press: 24 October 2022
Book contents
- Cardiopulmonary Bypass
- Cardiopulmonary Bypass
- Copyright page
- Contents
- Contributors
- Foreword
- Chapter 1 Human Factors and Teamwork in Cardiac Surgery
- Chapter 2 Equipment for Cardiopulmonary Bypass
- Chapter 3 Monitoring during Cardiopulmonary Bypass
- Chapter 4 Cardiopulmonary Bypass Circuit Setup and Safety Checks
- Chapter 5 Priming Solutions for Cardiopulmonary Bypass Circuits
- Chapter 6 Anticoagulation for Cardiopulmonary Bypass
- Chapter 7 Conduct of Cardiopulmonary Bypass
- Chapter 8 Minimal Invasive Extracorporeal Circulation
- Chapter 9 Considerations for Operations Involving Deep Hypothermic Circulatory Arrest
- Chapter 10 Metabolic Management during Cardiopulmonary Bypass
- Chapter 11 Myocardial Preservation during Cardiopulmonary Bypass
- Chapter 12 Weaning from Cardiopulmonary Bypass
- Chapter 13 Intraoperative Mechanical Circulatory Support and Other Uses of Cardiopulmonary Bypass
- Chapter 14 Mechanical Circulatory Support
- Chapter 15 Cardiopulmonary Bypass for Pediatric Cardiac Surgery
- Chapter 16 Coagulopathy and Hematological Disorders Associated with Cardiopulmonary Bypass
- Chapter 17 Inflammation and Organ Damage during Cardiopulmonary Bypass
- Chapter 18 Neuromonitoring and Cerebral Morbidity Associated with Cardiopulmonary Bypass
- Chapter 19 Renal Morbidity Associated with Cardiopulmonary Bypass
- Chapter 20 Common and Uncommon Disasters during Cardiopulmonary Bypass
- Index
- References
Summary
Anticoagulation is mandatory for any form of extra-corporeal circulation to prevent activation of the coagulation system through contact between blood and artificial surfaces and through blood stasis. The absence of sufficient anticoagulation is likely to result in clot formation within minutes of aortic cannulation and commencement of CPB, with detrimental consequences for the patient. This chapter briefly outlines the history of heparin before discussing its pharmacology, intraoperative hemostasis monitoring, the management of heparin resistance and Heparin Induced Thrombocytopenia (HIT) and the outlook for anticoagulation on CPB.
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- Cardiopulmonary Bypass , pp. 49 - 56Publisher: Cambridge University PressPrint publication year: 2022
References
Suggested Further Reading
Wardrop, D, Keeling, D. The story of the discovery of heparin and warfarin. Br J Haematol. 2008;141(6):757–763.CrossRefGoogle ScholarPubMed
Garcia, DA, Baglin, TP, Weitz, JI et al. Parenteral anticoagulants: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e24S–e43S.CrossRefGoogle ScholarPubMed
Bull, BS, Korpman, RA, Huse, WM et al. Heparin therapy during extracorporeal circulation. I. Problems inherent in existing heparin protocols. J Thorac Cardiovasc Surg. 1975;69(5):674–684.CrossRefGoogle ScholarPubMed
Welsby, IJ, McDonnell, E, El-Moalem, H et al. Activated clotting time systems vary in precision and bias and are not interchangeable when following heparin management protocols during cardiopulmonary bypass. J Clin Monit Comput. 2002;17(5):287–292.Google Scholar
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Shore-Lesserson, L, Baker, RA, Ferraris, VA et al. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines – Anticoagulation during Cardiopulmonary Bypass. Anesth Analg. 2018.CrossRefGoogle Scholar
Miles, LF, Coulson, TG, Galhardo, C et al. Pump priming practices and anticoagulation in cardiac curgery: Results from the Global Cardiopulmonary Bypass Survey. Anesth Analg. December, 2017; 125(6):1871–1877.CrossRefGoogle Scholar
Lemmer, JH Jr., Despotis, GJ. Antithrombin III concentrate to treat heparin resistance in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2002;123(2):213–217.Google Scholar
Chabata, CV, Frederiksen, JW, Sullenger, BA et al. Emerging applications of aptamers for anticoagulation and hemostasis. Curr Opin Hematol. 2018;25(5):382–388.Google Scholar