Cardiac surgery as a significant interference with a patient coagulation status

Overview

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.

Key words:
extracorporeal circuit – cardiac surgery – coagulation disorder