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management of coagulopathy

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Chapter 16 - Coagulopathy and Hematological Disorders Associated with Cardiopulmonary Bypass
- By Bruce D Spiess, Erik Ortmann
Edited by Florian Falter, Albert C. Perrino, Jr, Robert A. Baker
Book:

Cardiopulmonary Bypass

Published online:

24 October 2022

Print publication:

10 November 2022, pp 156-165
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Summary

CPB as well as surgical trauma have a significant impact on the usually well-balanced coagulation system. This often leads to bleeding complications, and interventions to restore this balance are frequently attempted perioperatively. The coagulation and inflammatory systems are so complex that restoration of homeostatic balance cannot be achieved by giving blood products alone. Major known causes of CPB associated coagulopathy are dilution, complex and variable platelet dysfunction, fibrinolysis, the effects of heparin and protamine, hypocalcemia, hypothermia, as well as activation of the coagulation system after contact with artificial surfaces and from tissue factor release from the endothelium in response to ischemia and reperfusion.