| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2001;72:S1821-S1831
© 2001 The Society of Thoracic Surgeons
a Departments of Anesthesiology, Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
* Address reprint requests to Dr Despotis, Departments of Anesthesiology, Pathology and Immunology, Washington University School of Medicine, 660 S Euclid, St. Louis, MO 63110, USA
e-mail: despotig{at}notes.wustl.edu
Presented at Mechanisms and Attenuation of Abnormalities in Hemostasis/Inflammation and Neurologic Injury: Implications for Patient Outcomes, Vancouver, BC, Canada, May 6, 2001.
Patients undergoing cardiac surgery with cardiopulmonary bypass are at risk for excessive microvascular bleeding, which often leads to transfusion of allogeneic blood and blood components as well as reexploration in a smaller subset of patients. Excessive bleeding after cardiac surgery is generally related to a combination of several alterations in the hemostatic system pertaining to hemodilution, excessive activation of the hemostatic system, and potentially the use of newer, longer-acting antiplatelet or antithrombotic agents.
Although several nonpharmacologic strategies have been proposed, this review summarizes the role of pharmacologic interventions as means to attenuate the alterations in the hemostatic system during CPB in an attempt to reduce excessive bleeding, transfusion, and reexploration. Specifically, agents that inhibit platelets, fibrinolysis, factor Xa and thrombin, as well as broad-spectrum agents, have been investigated with respect to their role in reducing consumption of clotting factors and better preservation of platelet function.
Prophylactic administration of agents with antifibrinolytic, anticoagulant, and possibly antiinflammatory properties can decrease blood loss and transfusion. Although aprotinin seems to be the most effective blood conservation agent (which is most likely related to its broad-spectrum nature), agents with isolated antifibrinolytic properties may be as effective in low-risk patients. The ability to reduce blood product transfusions and to decrease operative times and reexploration rates favorably affects patient outcomes, availability of blood products, and overall health care costs.
This article has been cited by other articles:
|
|
 |
|
  F. Maisano, H. K. Kjaergard, R. Bauernschmitt, A. Pavie, G. Rabago, M. Laskar, J. P. Marstein, and V. Falk TachoSil surgical patch versus conventional haemostatic fleece material for control of bleeding in cardiovascular surgery: a randomised controlled trial Eur. J. Cardiothorac. Surg., October 1, 2009; 36(4): 708 - 714. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. C. Oliver Anticoagulation and Coagulation Management for ECMO Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2009; 13(3): 154 - 175. [Abstract] [PDF]
|
|
|
|
|
|
A. Straub, D. Schiebold, H. P. Wendel, C. Hamilton, T. Wagner, E. Schmid, K. Dietz, and G. Ziemer Using reagent-supported thromboelastometry (ROTEM(R)) to monitor haemostatic changes in congenital heart surgery employing deep hypothermic circulatory arrest Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 641 - 647. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. D. Spiess Treating Heparin Resistance With Antithrombin or Fresh Frozen Plasma Ann. Thorac. Surg., June 1, 2008; 85(6): 2153 - 2160. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. C. Becker Emerging constructs to maintain safety among patients with acute coronary syndromes requiring surgical coronary revascularization Eur. Heart J. Suppl., May 1, 2008; 10(suppl_D): D12 - D22. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Mittermayr, W. Streif, T. Haas, D. Fries, C. Velik-Salchner, A. Klingler, and P. Innerhofer Effects of colloid and crystalloid solutions on endogenous activation of fibrinolysis and resistance of polymerized fibrin to recombinant tissue plasminogen activator added ex vivo Br. J. Anaesth., March 1, 2008; 100(3): 307 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. McEvoy, S. T. Reeves, J. G. Reves, and F. G. Spinale Aprotinin in Cardiac Surgery: A Review of Conventional and Novel Mechanisms of Action Anesth. Analg., October 1, 2007; 105(4): 949 - 962. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Johnson, M. B. Ross, and K. G. Moores Dosing factor VIIa (recombinant) in nonhemophiliac patients with bleeding after cardiac surgery Am. J. Health Syst. Pharm., September 1, 2007; 64(17): 1808 - 1812. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. P. Whitlock, M. A. Crowther, T. E. Warkentin, M.-H. Blackall, F. Farrokhyar, and K. H.T. Teoh Warfarin Cessation Before Cardiopulmonary Bypass: Lessons Learned from a Randomized Controlled Trial of Oral Vitamin K Ann. Thorac. Surg., July 1, 2007; 84(1): 103 - 108. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. N. Hoel, V. Videm, T. E. Mollnes, K. Saatvedt, F. Brosstad, A. E. Fiane, E. Fosse, and J. L. Svennevig Off-pump cardiac surgery abolishes complement activation Perfusion, July 1, 2007; 22(4): 251 - 256. [Abstract] [PDF]
|
|
|
|
|
|
E. B. Mossad, S. Machado, and J. Apostolakis Bleeding following deep hypothermia and circulatory arrest in children. Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2007; 11(1): 34 - 46. [Abstract] [PDF]
|
|
|
|
 |
|
 J. R. Cooper Jr, J. Abrams, O.H. Frazier, R. Radovancevic, B. Radovancevic, A. W. Bracey, M. J. Kindo, and I. D. Gregoric Fatal pulmonary microthrombi during surgical therapy for end-stage heart failure: Possible association with antifibrinolytic therapy J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 963 - 968. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D Belway, F D Rubens, D Wozny, B Henley, and H J Nathan Are we doing everything we can to conserve blood during bypass? A national survey Perfusion, September 1, 2005; 20(5): 237 - 241. [Abstract] [PDF]
|
|
|
|
|
|
M. Hyllner, E. Houltz, and A. Jeppsson Recombinant activated factor VII in the management of life-threatening bleeding in cardiac surgery Eur. J. Cardiothorac. Surg., August 1, 2005; 28(2): 254 - 258. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Khan, C. Bianchi, P. Voisine, J. Sandmeyer, J. Feng, and F. W. Sellke Aprotinin Inhibits Protease-Dependent Platelet Aggregation and Thrombosis Ann. Thorac. Surg., May 1, 2005; 79(5): 1545 - 1550. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. J Murphy, R. Ascione, and G. D Angelini Coronary artery bypass grafting on the beating heart: surgical revascularization for the next decade? Eur. Heart J., December 1, 2004; 25(23): 2077 - 2085. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Lindholm, M. Westerberg, A. Bengtsson, R. Ekroth, E. Jensen, and A. Jeppsson A Closed Perfusion System With Heparin Coating and Centrifugal Pump Improves Cardiopulmonary Bypass Biocompatibility in Elderly Patients Ann. Thorac. Surg., December 1, 2004; 78(6): 2131 - 2138. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. S. Donahue Factor V Leiden and Perioperative Risk Anesth. Analg., June 1, 2004; 98(6): 1623 - 1634. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Jensen, S. Andreasson, A. Bengtsson, H. Berggren, R. Ekroth, L. E. Larsson, and J. Ouchterlony Changes in hemostasis during pediatric heart surgery: impact of a biocompatible heparin-coated perfusion system Ann. Thorac. Surg., March 1, 2004; 77(3): 962 - 967. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Pretorius, L. J. Murphey, J. A. McFarlane, D. E. Vaughan, and N. J. Brown Angiotensin-Converting Enzyme Inhibition Alters the Fibrinolytic Response to Cardiopulmonary Bypass Circulation, December 23, 2003; 108(25): 3079 - 3083. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. S. Michalopoulos, S. Geroulanos, and S. D. Mentzelopoulos Determinants of Candidemia and Candidemia-Related Death in Cardiothoracic ICU Patients Chest, December 1, 2003; 124(6): 2244 - 2255. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. M. Fleck, H. Tschernich, M. Grabenwoger, D. Hutschala, H. Koinig, E. Wolner, and W. Mohl A double patch sandwich technique for surgical repair of acute aortic dissection type A Ann. Thorac. Surg., August 1, 2003; 76(2): 499 - 502. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. L. Chandler and T. Velan Estimating the rate of thrombin and fibrin generation in vivo during cardiopulmonary bypass Blood, June 1, 2003; 101(11): 4355 - 4362. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Chen-Scarabelli Beating-Heart Coronary Artery Bypass Graft Surgery: Indications, Advantages, and Limitations Crit. Care Nurse, October 1, 2002; 22(5): 44 - 58. [Full Text] [PDF]
|
|
|
|
|
|
J. D. Bui, G. D. Despotis, E. P. Trulock, G. A. Patterson, and L. T. Goodnough Fatal thrombosis after administration of activated prothrombin complex concentrates in a patient supported by extracorporeal membrane oxygenation who had received activated recombinant factor VII J. Thorac. Cardiovasc. Surg., October 1, 2002; 124(4): 852 - 854. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
