Vnitr Lek 2009, 55(3):233-235

Cardiac surgery as a significant interference with a patient coagulation status

R. Brát

Kardiochirurgické centrum FN Ostrava, přednosta prim. MUDr. Radim Brát, Ph.D.

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

Received: February 2, 2009; Published: March 1, 2009  Show citation