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Coagulation disorders of cardiopulmonary bypass: a review

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Abstract

Background

Postoperative bleeding is one of the most common complications of cardiac surgery.

Discussion

Extensive surgical trauma, prolonged blood contact with the artificial surface of the cardiopulmonary bypass (CPB) circuit, high doses of heparin, and hypothermia are all possible triggers of a coagulopathy leading to excessive bleeding. Platelet activation and dysfunction also occur and are caused mainly by heparin, hypothermia, and inadequate protamine administration. Heparin and protamine administration based on heparin concentrations as opposed to fixed doses may reduce coagulopathy and postoperative blood loss.

Conclusions

A better comprehension of the multifactorial mechanisms of activation of coagulation, inflammation, and fibrinolytic pathways during CPB may enable a more effective use of the technical and pharmaceutical options which are currently available.

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Authors and Affiliations

  1. Division of Cardiac Surgery, Dipartimento di Emergenza e Trapianti di Organo, University of Bari, Piazza Giulio Cesare 11, 70100, Bari, Italy

    Domenico Paparella

  2. Department of Surgery, University of Toronto, University Health Network, Department of Cardiovascular Surgery, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada

    Stephanie J. Brister

  3. Department of Pathology and Molecular Medicine, McMaster University Health Sciences Centre, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada

    Michael R. Buchanan

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  1. Domenico Paparella
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Correspondence to Domenico Paparella.

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Paparella, D., Brister, S.J. & Buchanan, M.R. Coagulation disorders of cardiopulmonary bypass: a review. Intensive Care Med 30, 1873–1881 (2004). https://doi.org/10.1007/s00134-004-2388-0

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