Advertisement

Problems Associated with Coagulation Monitoring during Cardiovascular Surgery

  • Jian-Sheng Wang
  • Wei-Te Hung
  • Bryan K. Lee
  • Robert B. Karp
  • Chung-Yuan Lin
Conference paper

Abstract

Despite the success of cardiac surgery and the improvement of cardiopulmonary bypass (CPB) instruments, life-threatening bleeding after CPB remains a serious problem that necessitates transfusion of blood components in a high percentage of patients and sometimes requires re-exploration. The incidence of hemorrhage is 5% to 18% in patients who have undergone open-heart procedures (1-4). Many different disorders can occur in patients undergoing CPB; this complicates the identification of specific causes and often delays effective treatment. The modification of routine coagulation tests and the application of new methods of detecting and treating coagulation abnormalities are focused on the reduction of morbidity and mortality in CPB patients. Thromboelastography (TEG) has been utilized for guiding the therapy of postoperative hemorrhage in cardiac patients (5). A system for quantitative determination of heparin concentration is now commercially available, which may obviate the disadvantages of the routine activated clotting time (ACT) measurement. It has recently been reported that, because of the anticoagulation effects of aprotinin, the need for heparin can be reduced in patients given aprotinin (6).

Keywords

Cardiopulmonary Bypass Activate Clotting Time Excessive Hemorrhage Heparin Concentration Coagulation Monitoring 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Gomes MMR, McGoon DC. Bleeding patterns after open-heart surgery. J Thorac Cardiovasc Surg 1970; 60: 87–97.PubMedGoogle Scholar
  2. 2.
    Bachmann F, McKenna R, Cole ER, Najafi H. The hemostatic mechanism after open-heart surgery. 1. Studies on plasma coagulation factors and fibrinolysis in 512 patients after extracorporeal circulation. J Thorac Cardiovasc Surg 1975; 70: 76–85.PubMedGoogle Scholar
  3. 3.
    McKenna R, Bechmann F, Whittaker B, Gilson JR, Weinberg M. The hemostatic mechanism after open-heart surgery. II. Frequency of abnormal platelet functions during and after extracorporeal circulation. J Thorac Cardiovasc Surg 1975; 70: 298–308.PubMedGoogle Scholar
  4. 4.
    Kirklin JK, Westaby S, Blackstone EH, Kirklin JW, Chenoweth DE, Pacifico AD. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg 1983; 86: 845–857.PubMedGoogle Scholar
  5. 5.
    Spiess BD, Tuman KJ, McCarthy RJ, DeLaria GA, Schillo R, Ivankovich AD. Thromboelastography as an indicator of post- cardiopulmonary bypass coagulopathies. J Clin Monit 1987; 3: 25–30.PubMedCrossRefGoogle Scholar
  6. 6.
    de Smet AAEA, Joen MCN, van Oeveren W, Roozendaal KJ, Harder MP, Eijsman L, Wildevuur CRH. Increased anticoagulation during cardiopulmonary bypass by aprotinin. J Thorac Cardiovasc Surg 1990; 100: 520 – 527.PubMedGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 1992

Authors and Affiliations

  • Jian-Sheng Wang
    • 1
  • Wei-Te Hung
    • 1
  • Bryan K. Lee
    • 2
  • Robert B. Karp
    • 2
  • Chung-Yuan Lin
    • 1
  1. 1.Departments of Anesthesia & Critical CareThe University of Chicago HospitalsChicagoUSA
  2. 2.Departments of Anesthesia & SurgeryThe University of Chicago HospitalsChicagoUSA

Personalised recommendations