Coagulopathy in Cardiac Surgery: Etiology and Treatment Options

This chapter reviews the causes and outlines an approach to the management of coagulopathy following cardiac surgery. Bleeding after cardiac surgery is common and expected up to a rate of 2 mL/kg/h for the first 6 hours. A more significant hemorrhage needs to be investigated and treated. Causes are often multifactorial. It is imperative that surgical causes be excluded early concomitant to providing resuscitation, investigating other medical causes for bleeding, and treating coagulopathy empirically until laboratory testing becomes available. The most frequent causes for coagulopathy post–cardiac surgery are excess heparinization, prolonged cardiopulmonary bypass time, hypothermia, acidosis, and preexisting bleeding diathesis. The management of coagulopathy implies maintenance of the normal physiological conditions for coagulation, reversal of excess heparinization, treatment of hyperfibrinolysis, maintaining normal levels of coagulation factors, and transfusion of platelets if thrombocytopenia or platelet dysfunction occurs. The chapter reviews what is involved in standard laboratory testing (complete blood count, prothrombin time, activated partial thromboplastin time, fibrinogen level, etc.) for coagulopathy. Also discussed is point-of-care testing and how the results from these tests should be interpreted. The chapter details the various blood products that are required in this scenario and suggests doses and transfusion thresholds.