Updates on Coagulation Management in Cardiac Surgery

Perioperative coagulopathy is regularly observed in patients undergoing cardiovascular surgery and is associated with massive bleeding, increased need for blood products transfusion, and re-exploration for surgical hemostasis. All these factors will exert a negative impact on postoperative morbidity, mortality, and costs. Coagulopathy is related either to preoperative etiologies (e.g. anticoagulants, antiplatelet agents, and hereditary bleeding disorders) or to intraoperative factors (e.g. hemodilution, activation and consumption of coagulation factors and platelets, heparin administration, hypothermia, hypocalcaemia, metabolic acidosis, and excessive fibrinolysis).  Both preventive and therapeutic measures are recommended for the perioperative management of coagulopathy. A cornerstone of bleeding reduction and blood product administration is the prophylactic administration of antifibrinolytic agents. On the other hand, the increased availability of point-of-care (POC) devices for use in the perioperative setting has allowed rapid bedside assessment of coagulopathy. This new approach enables physicians to adopt a goal-directed approach in which therapy specifically targets the underlying hemostatic pathology.