Cardiac surgery as a significant interference with a patient coagulation status

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.

Keywords: extracorporeal circuit; cardiac surgery; coagulation disorder