Skip to main content
SpringerLink
Log in

Perioperative Coagulation in Cardiovascular Surgery

  • Chapter
  • First Online:
Perioperative Hemostasis

  • 2328 Accesses

Abstract

The evolution of scientific knowledge in cardiac surgery and cardiopulmonary bypass has enabled the reduction of perioperative complications, despite an increase in patient-related risks and in the complexity of surgical procedures. However, the management of hemostasis and coagulation remains a difficult issue, and it is of note that the rates of allogeneic blood transfusion and surgical revision in bleeding patients have not declined in recent years. The perioperative coagulopathy in patients undergoing cardiac surgical procedures is a highly complex and challenging field, and appropriate management is essential to improve morbidity and mortality. Identifying the patient’s preoperative hemorrhagic risk factors and understanding the mechanisms involved in coagulopathy and fibrinolysis during cardiopulmonary bypass are crucial for the patient’s care. Today, the use of practice guidelines and point-of-care testing is an established part of the management of the bleeding patient. In this chapter, we review the state of knowledge on perioperative hemostasis management in cardiac surgery and describe some specific points on the pathophysiology and pharmacology of CPB-related coagulopathies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Alghamdi AA, Davis A et al (2006) Development and validation of Transfusion Risk Understanding Scoring Tool (TRUST) to stratify cardiac surgery patients according to their blood transfusion needs. Transfusion 46(7):1120–1129

    PubMed  Google Scholar 

  • Antoniou T, Kapetanakis EI et al (2002) Cardiac surgery in patients with heparin-induced thrombocytopenia using preoperatively determined dosages of iloprost. Heart Surg Forum 5(4):354–357

    PubMed  Google Scholar 

  • Arthurs Z, Cuadrado D et al (2006) The impact of hypothermia on trauma care at the 31st combat support hospital. Am J Surg 191(5):610–614

    PubMed  Google Scholar 

  • Avidan MS, Levy JH et al (2005) Recombinant human antithrombin III restores heparin responsiveness and decreases activation of coagulation in heparin-resistant patients during cardiopulmonary bypass. J Thorac Cardiovasc Surg 130(1):107–113

    PubMed  CAS  Google Scholar 

  • Berger JS, Frye CB et al (2008) Impact of clopidogrel in patients with acute coronary syndromes requiring coronary artery bypass surgery: a multicenter analysis. J Am Coll Cardiol 52(21):1693–1701

    PubMed  CAS  Google Scholar 

  • Butler K, Teng R (2010) Pharmacokinetics, pharmacodynamics, safety and tolerability of multiple ascending doses of ticagrelor in healthy volunteers. Br J Clin Pharmacol 70(1):65–77

    PubMed  CAS  PubMed Central  Google Scholar 

  • Cammerer U, Dietrich W et al (2003) The predictive value of modified computerized thromboelastography and platelet function analysis for postoperative blood loss in routine cardiac surgery. Anesth Analg 96(1):51–57, table of contents

    PubMed  Google Scholar 

  • Campbell FW, Goldstein MF et al (1984) Management of the patient with protamine hypersensitivity for cardiac surgery. Anesthesiology 61(6):761–764

    PubMed  CAS  Google Scholar 

  • Campbell DJ, Dixon B et al (2001) Activation of the kallikrein-kinin system by cardiopulmonary bypass in humans. Am J Physiol Regul Integr Comp Physiol 281(4):R1059–R1070

    PubMed  CAS  Google Scholar 

  • Chandler WL, Velan T (2003) Estimating the rate of thrombin and fibrin generation in vivo during cardiopulmonary bypass. Blood 101(11):4355–4362

    PubMed  CAS  Google Scholar 

  • Chandler WL, Velan T (2004) Plasmin generation and D-dimer formation during cardiopulmonary bypass. Blood Coagul Fibrinolysis 15(7):583–591

    PubMed  CAS  Google Scholar 

  • Chandler WL, Alessi MC et al (2000) Formation, inhibition and clearance of plasmin in vivo. Haemostasis 30(4):204–218

    PubMed  CAS  Google Scholar 

  • Chung J, Suzuki H et al (2007) Identification of tissue factor and platelet-derived particles on leukocytes during cardiopulmonary bypass by flow cytometry and immunoelectron microscopy. Thromb Haemost 98(2):368–374

    PubMed  CAS  Google Scholar 

  • Danese S, Vetrano S et al (2010) The protein C pathway in tissue inflammation and injury: pathogenic role and therapeutic implications. Blood 115(6):1121–1130

    PubMed  CAS  PubMed Central  Google Scholar 

  • Davidson SJ, McGrowder D et al (2008) Can ROTEM thromboelastometry predict postoperative bleeding after cardiac surgery? J Cardiothorac Vasc Anesth 22(5):655–661

    PubMed  Google Scholar 

  • de Haan J, van Oeveren W (1998) Platelets and soluble fibrin promote plasminogen activation causing downregulation of platelet glycoprotein Ib/IX complexes: protection by aprotinin. Thromb Res 92(4):171–179

    PubMed  Google Scholar 

  • de Haan J, Schonberger J et al (1993) Tissue-type plasminogen activator and fibrin monomers synergistically cause platelet dysfunction during retransfusion of shed blood after cardiopulmonary bypass. J Thorac Cardiovasc Surg 106(6):1017–1023

    PubMed  Google Scholar 

  • De Somer F, Van Belleghem Y et al (2002) Tissue factor as the main activator of the coagulation system during cardiopulmonary bypass. J Thorac Cardiovasc Surg 123(5):951–958

    PubMed  Google Scholar 

  • DeFoe GR, Ross CS et al (2001) Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group. Ann Thorac Surg 71(3):769–776

    PubMed  CAS  Google Scholar 

  • Dehmer GJ, Fisher M et al (1995) Reversal of heparin anticoagulation by recombinant platelet factor 4 in humans. Circulation 91(8):2188–2194

    PubMed  CAS  Google Scholar 

  • Despotis GJ, Joist JH et al (1995) The impact of heparin concentration and activated clotting time monitoring on blood conservation. A prospective, randomized evaluation in patients undergoing cardiac operation. J Thorac Cardiovasc Surg 110(1):46–54

    PubMed  CAS  Google Scholar 

  • Diago MC, Garcia-Unzueta MT et al (1997) Serum soluble selectins in patients undergoing cardiopulmonary bypass. Relationship with circulating blood cells and inflammation-related cytokines. Acta Anaesthesiol Scand 41(6):725–730

    PubMed  CAS  Google Scholar 

  • Dyke CM, Aldea G et al (2007) Off-pump coronary artery bypass with bivalirudin for patients with heparin-induced thrombocytopenia or antiplatelet factor four/heparin antibodies. Ann Thorac Surg 84(3):836–839

    PubMed  Google Scholar 

  • Edwards JT, Hamby JK et al (2003) Successful use of Argatroban as a heparin substitute during cardiopulmonary bypass: heparin-induced thrombocytopenia in a high-risk cardiac surgical patient. Ann Thorac Surg 75(5):1622–1624

    PubMed  Google Scholar 

  • el Habbal MH, Carter H et al (1995) Neutrophil activation in paediatric extracorporeal circuits: effect of circulation and temperature variation. Cardiovasc Res 29(1):102–107

    PubMed  Google Scholar 

  • Engstrom M, Schott U et al (2006) Acidosis impairs the coagulation: a thromboelastographic study. J Trauma 61(3):624–628

    PubMed  Google Scholar 

  • Fang WC, Helm RE et al (1997) Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery. Circulation 96(9 Suppl):II-194–II-199

    Google Scholar 

  • Finley A, Greenberg C (2013) Review article: heparin sensitivity and resistance: management during cardiopulmonary bypass. Anesth Analg 116(6):1210–1222

    PubMed  CAS  Google Scholar 

  • Fitchett D, Eikelboom J et al (2009) Dual antiplatelet therapy in patients requiring urgent coronary artery bypass grafting surgery: a position statement of the Canadian Cardiovascular Society. Can J Cardiol 25(12):683–689

    PubMed  CAS  PubMed Central  Google Scholar 

  • Franz A, Braunlich P et al (2001) The effects of hydroxyethyl starches of varying molecular weights on platelet function. Anesth Analg 92(6):1402–1407

    PubMed  CAS  Google Scholar 

  • Freyburger G, Janvier G et al (1993) Fibrinolytic and hemorheologic alterations during and after elective aortic graft surgery: implications for postoperative management. Anesth Analg 76(3):504–512

    PubMed  CAS  Google Scholar 

  • Frick PG, Brogli H (1966) The mechanism of heparin rebound after extracorporeal circulation for open cardiac surgery. Surgery 59(5):721–726

    PubMed  CAS  Google Scholar 

  • Furukawa K, Ohteki H et al (2001) The use of argatroban as an anticoagulant for cardiopulmonary bypass in cardiac operations. J Thorac Cardiovasc Surg 122(6):1255–1256

    PubMed  CAS  Google Scholar 

  • Gallandat Huet RC, Siemons AW et al (2000) A novel hydroxyethyl starch (Voluven) for effective perioperative plasma volume substitution in cardiac surgery. Can J Anaesth 47(12):1207–1215

    PubMed  CAS  Google Scholar 

  • Hajjar LA, Vincent JL et al (2010) Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA 304(14):1559–1567

    PubMed  CAS  Google Scholar 

  • Hongo RH, Ley J et al (2002) The effect of clopidogrel in combination with aspirin when given before coronary artery bypass grafting. J Am Coll Cardiol 40(2):231–237

    PubMed  CAS  Google Scholar 

  • Hunt BJ, Parratt RN et al (1998) Activation of coagulation and fibrinolysis during cardiothoracic operations. Ann Thorac Surg 65(3):712–718

    PubMed  CAS  Google Scholar 

  • Jobes DR, Aitken GL et al (1995) Increased accuracy and precision of heparin and protamine dosing reduces blood loss and transfusion in patients undergoing primary cardiac operations. J Thorac Cardiovasc Surg 110(1):36–45

    PubMed  CAS  Google Scholar 

  • Karkouti K, Beattie WS et al (2005) Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg 129(2):391–400

    PubMed  CAS  Google Scholar 

  • Karkouti K, O’Farrell R et al (2006) Prediction of massive blood transfusion in cardiac surgery. Can J Anaesth 53(8):781–794

    PubMed  Google Scholar 

  • Koch CG, Li L et al (2006) Transfusion in coronary artery bypass grafting is associated with reduced long-term survival. Ann Thorac Surg 81(5):1650–1657

    PubMed  Google Scholar 

  • Koster A, Hansen R et al (2000a) Recombinant hirudin as an alternative for anticoagulation during cardiopulmonary bypass in patients with heparin-induced thrombocytopenia type II: a 1-year experience in 57 patients. J Cardiothorac Vasc Anesth 14(3):243–248

    PubMed  CAS  Google Scholar 

  • Koster A, Loebe M et al (2000b) Cardiopulmonary bypass in a patient with heparin-induced thrombocytopenia II and impaired renal function using heparin and the platelet GP IIb/IIIa inhibitor tirofiban as anticoagulant. Ann Thorac Surg 70(6):2160–2161

    PubMed  CAS  Google Scholar 

  • Koster A, Kukucka M et al (2001) Anticoagulation during cardiopulmonary bypass in patients with heparin-induced thrombocytopenia type II and renal impairment using heparin and the platelet glycoprotein IIb-IIIa antagonist tirofiban. Anesthesiology 94(2):245–251

    PubMed  CAS  Google Scholar 

  • Koster A, Chew D et al (2003) High antithrombin III levels attenuate hemostatic activation and leukocyte activation during cardiopulmonary bypass. J Thorac Cardiovasc Surg 126(3):906–907

    PubMed  Google Scholar 

  • Koster A, Dyke CM et al (2007) Bivalirudin during cardiopulmonary bypass in patients with previous or acute heparin-induced thrombocytopenia and heparin antibodies: results of the CHOOSE-ON trial. Ann Thorac Surg 83(2):572–577

    PubMed  Google Scholar 

  • Koster A, Buz S et al (2009) Bivalirudin anticoagulation during cardiac surgery: a single-center experience in 141 patients. Perfusion 24(1):7–11

    PubMed  CAS  Google Scholar 

  • Lemmer JH Jr, Metzdorff MT et al (2000) Emergency coronary artery bypass graft surgery in abciximab-treated patients. Ann Thorac Surg 69(1):90–95

    PubMed  Google Scholar 

  • Levy JH, Despotis GJ et al (2002) Recombinant human transgenic antithrombin in cardiac surgery: a dose-finding study. Anesthesiology 96(5):1095–1102

    PubMed  CAS  Google Scholar 

  • Linkins LA, Dans AL et al (2012) Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e495S–e530S

    PubMed  CAS  PubMed Central  Google Scholar 

  • Litmathe J, Boeken U et al (2003) Predictors of homologous blood transfusion for patients undergoing open heart surgery. Thorac Cardiovasc Surg 51(1):17–21

    PubMed  CAS  Google Scholar 

  • Lo GK, Juhl D et al (2006) Evaluation of pretest clinical score (4T’s) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost 4(4):759–765

    PubMed  CAS  Google Scholar 

  • Lu H, Buit CD et al (1994) Postoperative hemostasis and fibrinolysis in patients undergoing cardiopulmonary bypass with or without aprotinin therapy. Thromb Haemost 72(3):438–443

    PubMed  CAS  Google Scholar 

  • Lubenow N, Eichler P et al (2005) Lepirudin in patients with heparin-induced thrombocytopenia – results of the third prospective study (HAT-3) and a combined analysis of HAT-1, HAT-2, and HAT-3. J Thromb Haemost 3(11):2428–2436

    PubMed  CAS  Google Scholar 

  • Madjdpour C, Spahn DR et al (2006) Anemia and perioperative red blood cell transfusion: a matter of tolerance. Crit Care Med 34(5 Suppl):S102–S108

    PubMed  Google Scholar 

  • Magovern JA, Sakert T et al (1996) A model for predicting transfusion after coronary artery bypass grafting. Ann Thorac Surg 61(1):27–32

    PubMed  CAS  Google Scholar 

  • Mangoush O, Purkayastha S et al (2007) Heparin-bonded circuits versus nonheparin-bonded circuits: an evaluation of their effect on clinical outcomes. Eur J Cardiothorac Surg 31(6):1058–1069

    PubMed  Google Scholar 

  • Mannucci PM, Levi M (2007) Prevention and treatment of major blood loss. N Engl J Med 356(22):2301–2311

    PubMed  CAS  Google Scholar 

  • Mao Y, Jin J et al (2009) Regulation of plasmin-induced protease-activated receptor 4 activation in platelets. Platelets 20(3):191–198

    PubMed  CAS  Google Scholar 

  • Meng ZH, Wolberg AS et al (2003) The effect of temperature and pH on the activity of factor VIIa: implications for the efficacy of high-dose factor VIIa in hypothermic and acidotic patients. J Trauma 55(5):886–891

    PubMed  CAS  Google Scholar 

  • Michelsen LG, Kikura M et al (1996) Heparinase I (neutralase) reversal of systemic anticoagulation. Anesthesiology 85(2):339–346

    PubMed  CAS  Google Scholar 

  • Nybo M, Madsen JS (2008) Serious anaphylactic reactions due to protamine sulfate: a systematic literature review. Basic Clin Pharmacol Toxicol 103(2):192–196

    PubMed  CAS  Google Scholar 

  • Ozier Y, Bellamy L (2010) Pharmacological agents: antifibrinolytics and desmopressin. Best Pract Res Clin Anaesthesiol 24(1):107–119

    PubMed  CAS  Google Scholar 

  • Paparella D, Cappabianca G et al (2009) Antithrombin after cardiac surgery: implications on short and mid-term outcome. J Thromb Thrombolysis 27(1):105–114

    PubMed  CAS  Google Scholar 

  • Pickard AS, Becker RC et al (2008) Clopidogrel-associated bleeding and related complications in patients undergoing coronary artery bypass grafting. Pharmacotherapy 28(3):376–392

    PubMed  CAS  Google Scholar 

  • Pouplard C, May MA et al (2005) Changes in platelet count after cardiac surgery can effectively predict the development of pathogenic heparin-dependent antibodies. Br J Haematol 128(6):837–841

    PubMed  Google Scholar 

  • Pouplard C, Gueret P et al (2007) Prospective evaluation of the ‘4Ts’ score and particle gel immunoassay specific to heparin/PF4 for the diagnosis of heparin-induced thrombocytopenia. J Thromb Haemost 5(7):1373–1379

    PubMed  CAS  Google Scholar 

  • Purkayastha S, Athanasiou T et al (2006) Does clopidogrel affect outcome after coronary artery bypass grafting? A meta-analysis. Heart 92(4):531–532

    PubMed  CAS  PubMed Central  Google Scholar 

  • Quinton TM, Kim S et al (2004) Plasmin-mediated activation of platelets occurs by cleavage of protease-activated receptor 4. J Biol Chem 279(18):18434–18439

    PubMed  CAS  Google Scholar 

  • Ranucci M, Castelvecchio S (2009) Management of mini-cardiopulmonary bypass devices: is it worth the energy? Curr Opin Anaesthesiol 22(1):78–83

    PubMed  Google Scholar 

  • Ranucci M, Frigiola A et al (2005a) Postoperative antithrombin levels and outcome in cardiac operations. Crit Care Med 33(2):355–360

    PubMed  CAS  Google Scholar 

  • Ranucci M, Romitti F et al (2005b) Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations. Ann Thorac Surg 80(6):2213–2220

    PubMed  Google Scholar 

  • Ranucci M, Balduini A et al (2009a) A systematic review of biocompatible cardiopulmonary bypass circuits and clinical outcome. Ann Thorac Surg 87(4):1311–1319

    PubMed  Google Scholar 

  • Ranucci M, Castelvecchio S et al (2009b) Predicting transfusions in cardiac surgery: the easier, the better: the Transfusion Risk and Clinical Knowledge score. Vox Sang 96(4):324–332

    PubMed  CAS  Google Scholar 

  • Ranucci M, Baryshnikova E et al (2011) Multiple electrode whole-blood aggregometry and bleeding in cardiac surgery patients receiving thienopyridines. Ann Thorac Surg 91(1):123–129

    PubMed  Google Scholar 

  • Riess FC, Poetzsch B et al (2007) Recombinant hirudin for cardiopulmonary bypass anticoagulation: a randomized, prospective, and heparin-controlled pilot study. Thorac Cardiovasc Surg 55(4):233–238

    PubMed  Google Scholar 

  • Rivard GE, Brummel-Ziedins KE et al (2005) Evaluation of the profile of thrombin generation during the process of whole blood clotting as assessed by thromboelastography. J Thromb Haemost 3(9):2039–2043

    PubMed  CAS  PubMed Central  Google Scholar 

  • Shore-Lesserson L, Manspeizer HE et al (1999) Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery. Anesth Analg 88(2):312–319

    PubMed  CAS  Google Scholar 

  • Shuhaibar MN, Hargrove M et al (2004) How much heparin do we really need to go on pump? A rethink of current practices. Eur J Cardiothorac Surg 26(5):947–950

    PubMed  CAS  Google Scholar 

  • Slaughter TF, Sreeram G et al (2001) Reversible shear-mediated platelet dysfunction during cardiac surgery as assessed by the PFA-100 platelet function analyzer. Blood Coagul Fibrinolysis 12(2):85–93

    PubMed  CAS  Google Scholar 

  • Sniecinski RM, Chandler WL (2011) Activation of the hemostatic system during cardiopulmonary bypass. Anesth Analg 113(6):1319–1333

    PubMed  Google Scholar 

  • Snyder-Ramos SA, Mohnle P et al (2008) The ongoing variability in blood transfusion practices in cardiac surgery. Transfusion 48(7):1284–1299

    PubMed  Google Scholar 

  • Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Ferraris VA et al (2007) Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg 83(5 Suppl):S27–S86

    PubMed  Google Scholar 

  • Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Ferraris VA et al (2011) 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 91(3):944–982

    PubMed  Google Scholar 

  • Spahn DR, Dettori N et al (2004) Transfusion in the cardiac patient. Crit Care Clin 20(2):269–279

    PubMed  Google Scholar 

  • Stover EP, Siegel LC et al (1998) Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines: a 24-institution study. Institutions of the Multicenter Study of Perioperative Ischemia Research Group. Anesthesiology 88(2):327–333

    PubMed  CAS  Google Scholar 

  • Suttner S, Piper SN et al (2004) The influence of allogeneic red blood cell transfusion compared with 100 % oxygen ventilation on systemic oxygen transport and skeletal muscle oxygen tension after cardiac surgery. Anesth Analg 99(1):2–11

    PubMed  Google Scholar 

  • Szalados JE, Ouriel K, Shapiro JR (1994) Use of the activated coagulation time and heparin dose-response curve for the determination of protamine dosage in vascular surgery. J Cardiothorac Vasc Anesth. 8(5):515–518

    Google Scholar 

  • Tabuchi N, Shibamiya A et al (2003) Activated leukocytes adsorbed on the surface of an extracorporeal circuit. Artif Organs 27(6):591–594

    PubMed  Google Scholar 

  • Task Force on Myocardial Revascularization of the European Society of, C., S. the European Association for Cardio-Thoracic et al (2010) Guidelines on myocardial revascularization. Eur J Cardiothorac Surg 38(Suppl):S1–S52

    Google Scholar 

  • Vallely MP, Bannon PG et al (2009) Quantitative and temporal differences in coagulation, fibrinolysis and platelet activation after on-pump and off-pump coronary artery bypass surgery. Heart Lung Circ 18(2):123–130

    PubMed  Google Scholar 

  • Velik-Salchner C, Maier S et al (2009) An assessment of cardiopulmonary bypass-induced changes in platelet function using whole blood and classical light transmission aggregometry: the results of a pilot study. Anesth Analg 108(6):1747–1754

    PubMed  Google Scholar 

  • Wang G, Bainbridge D et al (2009) The efficacy of an intraoperative cell saver during cardiac surgery: a meta-analysis of randomized trials. Anesth Analg 109(2):320–330

    PubMed  CAS  Google Scholar 

  • Warkentin TE, Kelton JG (1996) A 14-year study of heparin-induced thrombocytopenia. Am J Med 101(5):502–507

    PubMed  CAS  Google Scholar 

  • Warkentin TE, Sheppard JA et al (2000) Impact of the patient population on the risk for heparin-induced thrombocytopenia. Blood 96(5):1703–1708

    PubMed  CAS  Google Scholar 

  • Warkentin TE, Greinacher A et al (2008) Treatment and prevention of heparin-induced thrombocytopenia: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133(6 Suppl):340S–380S

    PubMed  CAS  Google Scholar 

  • Weber CF, Gorlinger K et al (2012) Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology 117(3):531–547

    PubMed  Google Scholar 

  • Weiler H (2010) Regulation of inflammation by the protein C system. Crit Care Med 38(2 Suppl):S18–S25

    PubMed  CAS  Google Scholar 

  • Wheeldon DR, Bethune DW et al (1990) Vortex pumping for routine cardiac surgery: a comparative study. Perfusion 5(2):135–143

    PubMed  CAS  Google Scholar 

  • Wiviott SD, Braunwald E et al (2007) Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 357(20):2001–2015

    PubMed  CAS  Google Scholar 

  • Yende S, Wunderink RG (2001) Effect of clopidogrel on bleeding after coronary artery bypass surgery. Crit Care Med 29(12):2271–2275

    PubMed  CAS  Google Scholar 

  • Young JA, Kisker CT, Doty DB (1978) Adequate anticoagulation during cardiopulmonary bypass determined by activated clotting time and the appearance of fibrin monomer. Ann Thorac Surg. 26(3):231–240

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, CH-1011, Switzerland

    Fabrizio Gronchi

  2. Department of Anesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097, San Donato Milanese, Milan, Italy

    Marco Ranucci

Authors
  1. Fabrizio Gronchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Ranucci
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fabrizio Gronchi .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, University Hospital of Lausanne, Lausanne, Switzerland

    Carlo Enrique Marcucci

  2. Department of Anesthesiology, University Hospital of Lausanne, Lausanne, Switzerland

    Patrick Schoettker

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Gronchi, F., Ranucci, M. (2015). Perioperative Coagulation in Cardiovascular Surgery. In: Marcucci, C., Schoettker, P. (eds) Perioperative Hemostasis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-55004-1_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-55004-1_14

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-55003-4

  • Online ISBN: 978-3-642-55004-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation