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Postoperative Coagulation and Bleeding: Monitoring and Hematologic Management After Adult Cardiac Surgery

  • Dominic Emerson
  • Ali Dabbagh
Chapter

Abstract

There is a never-ending physiologic balance between thrombotic and antithrombotic factors in vivo. However, this balance changes to a major challenge in cardiac surgery which is a potential dilemma for postoperative care: what is the ideal goal in postoperative management of bleeding and hemostasis in these patients, especially when considering the importance of preoperative, intraoperative, and postoperative factors on the thrombosis and coagulation cascade?

The postoperative management of coagulation in adult cardiac surgery patients follows the rules of medicine with a specific focus on medication history, all coexisting diseases or comorbidities, including but not limited to previous events in the coagulation system. Postoperative test especially point-of-care battery of tests has an important role in the diagnosis of underlying conditions, TEG ® and ROTEM ® being part of these tests. Treatment includes pharmaceutical agents, blood component therapy, and surgical management, each of them with specific benefits, merits, and potential disadvantages which are discussed in detail in this chapter.

Keywords

Physiology of coagulation and bleeding Oral anticoagulants/antiplatelet agents Parenteral anticoagulants/antiplatelet agents Prothrombin time (PT) International normalized ratio (INR) Partial thromboplastin time (PTT) Platelet count Fibrinogen level Thromboelastography (TEG) Rotational thromboelastography (ROTEM) Heparin-induced thrombocytopenia (HIT) Antifibrinolytic agents Cryoprecipitate Fibrinogen Human prothrombin complex (PCC) Activated recombinant factor 7 (rFVIIa) Factor eight inhibitor bypass activity (FEIBA) Surgical management of bleeding 

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Authors and Affiliations

  1. 1.Cardiothoracic Surgery, Department of SurgeryCedars Sinai Medical CenterLos AngelesUSA
  2. 2.Faculty of Medicine, Cardiac Anesthesiology Department, Anesthesiology Research CenterShahid Beheshti University of Medical SciencesTehranIran
  3. 3.Cardiac Anesthesiology Fellowship ProgramShahid Beheshti University of Medical SciencesTehranIran

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