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Cardiac surgery as a significant interference with a patient coagulation status


Authors: R. Brát
Authors place of work: Kardiochirurgické centrum FN Ostrava, přednosta prim. MUDr. Radim Brát, Ph. D.
Published in the journal: Vnitř Lék 2009; 55(3): 233-235
Category: 15th Parizek's Days

Summary

Cardiac surgery has been advancing intensively in recent years. However, it is often forgotten that cardiac surgery interventions represent a significant interference with patient’s coagulation status. This paper summarizes the main processes in the course cardiac surgery that lead to coagulation disorder. These include: • haemodilution resulting from extracorporeal circuits crystalloid priming and the use of cardioplegic solutions leading to the reduction in coagulation factors concentration and the thrombocytes count • full he­pa­rinisation during extracorporeal circulation that represents a significant interference with coagulation that may persist for some time even after all he­pa­rin has been bound • contact of the blood with inorganic surface that results in an activation of the coagulation cascade and subsequent consumption of coagulation factors and thrombocytes • surgery‑related trauma with activation of the external coagulation pathway leading to activation of the coagulation cascade and subsequent consumption of coagulation factors and thrombocytes • blood re‑transfusion from the pericardial cavity and subsequent activation of the external coagulation pathway leading to consumption of coagulation factors and thrombocytes • hypothermia leading to thrombocyte dysfunction and initiation of fibrinolysis • blood loss furthering the haemodilution and reduction in coagulation factors concentration and thrombocytes count. The overview provided suggests that cardiac surgery conducted with the support of extracorporeal circuit represents a significant interference with the coagulation status of the patient. Awareness of the above listed changes is necessary to secure correct post‑operative management of coagulation disorders.

Key words:
extracorporeal circuit – cardiac surgery – coagulation disorder


Zdroje

1. Hunt BJ, Parratt RN, Segal HC et al. Activation of Coagulation and Fibrinolysis During Cardiothoracic Operations. Ann Thorac Surg 1998; 65: 712–718.

2. Chandler WL, Velan T. Estimating the rate of thrombin and fibrin generation in vivo during cardiopulmonary bypass. Blood 2003; 101: 4355–4362.

3. Mariani MA, Gu YJ, Boonstra PW et al. Procoagulant activity after off-pump coronary operation: is the current anticoagulation adequate? Ann Thorac Surg 1999; 67: 1370–1375.

4. Brát R, Tošovský J, Januška J et al. Comparison between blood and crystalloid cardioplegia in patients with left ventricular dysfunction undergoing coronary surgery. Acta Medica (Hradec Králové) 2000; 43: 107–110.

5. Dixon B, Santamaria J, Campbell D. Coagulation Activation and Organ Dysfunction Following Cardiac Surgery. Chest 2005; 128: 229–236.

6. Despotis GJ, Joist JH, Goodnough LT. Monitoring of hemostasis in cardiac surgical patients: impact of point-of-care testing on blood loss and transfusion outcomes. Clin Chem 1997; 43: 1684–1696.

Štítky
Diabetology Endocrinology Internal medicine

Článok vyšiel v časopise

Internal Medicine

Číslo 3

2009 Číslo 3
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