Mechanisms and attenuation of hemostatic activation during extracorporeal circulation

George J. Despotis, Michael S. Avidan, Charles W. Hogue

Research output: Contribution to journalArticle

Abstract

Patients undergoing cardiac surgery with cardiopulmonary bypass are at risk for excessive microvascular bleeding, which often leads to transfusion of allogeneic blood and blood components as well as reexploration in a smaller subset of patients. Excessive bleeding after cardiac surgery is generally related to a combination of several alterations in the hemostatic system pertaining to hemodilution, excessive activation of the hemostatic system, and potentially the use of newer, longer-acting antiplatelet or antithrombotic agents. Although several nonpharmacologic strategies have been proposed, this review summarizes the role of pharmacologic interventions as means to attenuate the alterations in the hemostatic system during CPB in an attempt to reduce excessive bleeding, transfusion, and reexploration. Specifically, agents that inhibit platelets, fibrinolysis, factor Xa and thrombin, as well as broad-spectrum agents, have been investigated with respect to their role in reducing consumption of clotting factors and better preservation of platelet function. Prophylactic administration of agents with antifibrinolytic, anticoagulant, and possibly antiinflammatory properties can decrease blood loss and transfusion. Although aprotinin seems to be the most effective blood conservation agent (which is most likely related to its broad-spectrum nature), agents with isolated antifibrinolytic properties may be as effective in low-risk patients. The ability to reduce blood product transfusions and to decrease operative times and reexploration rates favorably affects patient outcomes, availability of blood products, and overall health care costs.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
Volume72
Issue number5
DOIs
StatePublished - 2001
Externally publishedYes

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Extracorporeal Circulation
Hemostatics
Blood Transfusion
Antifibrinolytic Agents
Hemorrhage
Thoracic Surgery
Blood Platelets
Hemodilution
Factor Xa
Aprotinin
Blood Coagulation Factors
Fibrinolytic Agents
Platelet Aggregation Inhibitors
Fibrinolysis
Operative Time
Cardiopulmonary Bypass
Thrombin
Health Care Costs
Anticoagulants
Anti-Inflammatory Agents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Mechanisms and attenuation of hemostatic activation during extracorporeal circulation. / Despotis, George J.; Avidan, Michael S.; Hogue, Charles W.

In: Annals of Thoracic Surgery, Vol. 72, No. 5, 2001.

Research output: Contribution to journalArticle

Despotis, George J. ; Avidan, Michael S. ; Hogue, Charles W. / Mechanisms and attenuation of hemostatic activation during extracorporeal circulation. In: Annals of Thoracic Surgery. 2001 ; Vol. 72, No. 5.
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