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Chapter 16 - Coagulopathy and Hematological Disorders Associated with Cardiopulmonary Bypass

Published online by Cambridge University Press:  24 October 2022

By
Bruce D Spiess  and
Erik Ortmann
Edited by
Florian Falter ,
Albert C. Perrino, Jr  and
Robert A. Baker
Florian Falter
Affiliation:
Royal Papworth Hospital, Cambridge
Albert C. Perrino, Jr
Affiliation:
Yale University Medical Center, Connecticut
Robert A. Baker
Affiliation:
Flinders Medical Centre, Adelaide
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Summary

CPB as well as surgical trauma have a significant impact on the usually well-balanced coagulation system. This often leads to bleeding complications, and interventions to restore this balance are frequently attempted perioperatively. The coagulation and inflammatory systems are so complex that restoration of homeostatic balance cannot be achieved by giving blood products alone. Major known causes of CPB associated coagulopathy are dilution, complex and variable platelet dysfunction, fibrinolysis, the effects of heparin and protamine, hypocalcemia, hypothermia, as well as activation of the coagulation system after contact with artificial surfaces and from tissue factor release from the endothelium in response to ischemia and reperfusion.

Keywords

Bypass Associated CoagulopathyDual Antiplatelet TherapyWarfarinNovel Oral AnticoagulantsAssessment of CoagulopathyManagement of CoagulopathyBlood TransfusionPatient Blood ManagementBlood Conservation
Type
Chapter
Information
Cardiopulmonary Bypass , pp. 156 - 165
Publisher: Cambridge University Press
Print publication year: 2022

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References

Suggested Further Reading

Besser, MW, Klein, AA. The coagulopathy of cardiopulmonary bypass. Crit Rev Clin Lab Sci. 2010; 47: 197–212.CrossRefGoogle ScholarPubMed
Hofer, J, Fries, D, Solomon, C et al. A snapshot of coagulopathy after cardiopulmonary bypass. Clin Appl Thromb Hemost. 2016; 22: 505–511.CrossRefGoogle ScholarPubMed
Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic S, the European Association of Cardiothoracic A, Boer C et al. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth. 2018; 32: 88–120.Google Scholar
Ortmann, E, Besser, MW, Klein, AA. Antifibrinolytic agents in current anaesthetic practice. Br J Anaesth. 2013; 111: 549–563.Google Scholar
RCoS. Caring for patients who refuse blood – a guide to good practice. 2016.Google Scholar
Jassar, AS, Ford, PA, Haber, HL et al. Cardiac surgery in Jehovah’s Witness patients: ten-year experience. Ann Thorac Surg. 2012; 93: 19–25.CrossRefGoogle ScholarPubMed
Tanaka, A, Ota, T, Uriel, N et al. Cardiovascular surgery in Jehovah’s Witness patients: The role of preoperative optimization. J Thorac Cardiovasc Surg. 2015; 150: 976-83.e1–3.Google Scholar
Vaislic, CD, Dalibon, N, Ponzio, O et al. Outcomes in cardiac surgery in 500 consecutive Jehovah’s Witness patients: 21 year experience. J Cardiothorac Surg. 2012; 7: 95.CrossRefGoogle ScholarPubMed
Patel, PA, Ghadimi, K, Coetzee, E et al. Incidental cold agglutinins in cardiac surgery: Intraoperative surprises and team-based problem-solving strategies during cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2017; 31: 1109–1118.Google Scholar
Jain, MD, Cabrerizo-Sanchez, R, Karkouti, K et al. Seek and you shall find – but then what do you do? Cold agglutinins in cardiopulmonary bypass and a single-center experience with cold agglutinin screening before cardiac surgery. Transfus Med Rev. 2013; 27: 65–73.Google Scholar

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