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Preventing and managing postoperative bleeding in cardiac surgery by controlling disseminated intravascular coagulation

Published online by Cambridge University Press:  01 June 2007

J. Szefner
J. Szefner*
Affiliation:
Haemostasis Cardiovascular Surgery Department, La Pitié Hospital, Paris, France
*
Correspondence to: Jacques Szefner, MD., Haemostasis Cardiovascular Surgery Department, La Pitie Hospital, Paris, France.
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Summary

Background and objectives

Bleeding in cardiac surgery is still one of the major concerns for cardiac surgeons and anaesthesiologists. The present review addresses the main pathophysiological mechanisms underlying bleeding after cardiac operations, and analyzes possible therapeutic strategies.

Methods

Overview of different bleeding mechanisms and related diagnostic and therapeutic approaches, with specific respect to disseminated intravascular coagulopathy.

Results

Biological bleeding after cardiac operations depends on the interaction of platelet activity, the procoagulant system, and the fibrinolytic system. A diagnostic and therapeutic approach based on a four-phase model of disseminated intravascular coagulation and haemostasis imbalance is presented. At each step, adequate diagnostic tools (thromboelastography and antithrombin activity) are required to make a diagnosis and guide the appropriate treatment.

Conclusions

Bleeding is not a fatality. Quite the contrary, it must be treated through a multi-system approach, and as early as possible, preferably at a biological phase before clinical bleeding. In addition, early monitoring and treatment adapted to each patient makes it possible to better follow a patient’s evolution and helps reduce the occurrence of later thromboembolic events.

Keywords

Bleeding; Cardiac surgery; DIC; Assist Devices; Thromboelastography; Antithrombin III
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue S40 , June 2007 , pp. 59 - 66
Copyright
Copyright © European Society of Anaesthesiology 2007

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References

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