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Coagulopathy in Cardiovascular Surgery

Release Date: June 30, 2006

Expiration Date: June 30, 2007

Estimated time to complete this Activity: 1 hour

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Overview

Hemorrhage and re-exploration for bleeding are some of the most important complications of cardiac surgery and can lead to increased morbidity and mortality after open heart surgery. Factors that increase the risk of bleeding in cardiovascular surgery include the increasing complexity of the surgical procedures and the use of aspirin or antifibrinolytic agents. Perioperative hemorrhage can be related to the transection of blood vessels (surgical bleeding) or to coagulopathic, nonsurgical bleeding. The etiology and management of coagulopathic bleeding is complicated by hyperfibrinolysis and platelet dysfunction. Cardiopulmonary bypass (CPB), commonly used in cardiovascular surgery, promotes bleeding and systemic fibrinolysis by disturbing the endothelial-mediated expression of anticoagulants and procoagulant substances. The use of CPB also can lead to thrombocytopenia as platelets are consumed or adhere to the CPB circuit. In addition, CPB can contribute to postpump syndrome, a complex inflammatory response involving humoral and cellular components that can culminate in organ dysfunction. This presentation will review the thrombotic and hemorrhagic problems associated with cardiovascular surgery. Identification of patients at risk of excessive bleeding, the impact of fibrinolytic activation on bleeding, and the importance of proper anticoagulation and heparin neutralization in CPB will be discussed. In addition, the presentation will evaluate the use of various therapeutic strategies in the management of bleeding and postpump syndrome related to cardiovascular surgery.

Target Audience

Coagulopathy in Cardiovascular Surgery is intended for transfusion specialists, hematologists, and other healthcare professionals involved in the management of patients undergoing cardiovascular surgery.

Learning Objectives

After completing this continuing medical education (CME) activity, participants should be able to:

• Describe the role of the vascular endothelium in mediating coagulation and thrombosis
• List the effects of cardiopulmonary bypass on endothelial-mediated hemostatic processes
• Describe the pathophysiology of postpump syndrome
• Evaluate the effects of newer antithrombotic, anticoagulant, and antiplatelet drugs on perioperative and postoperative bleeding in cardiovascular surgery
• List the management options for control of bleeding in cardiovascular surgery

Accreditation Statement

This activity has expired.

Designation Statement

This activity has expired.

How to Get Credit

This activity has expired.

Faculty Disclosure

It is the policy of the FCG Institute for Continuing Education that all faculty participating in continuing medical education activities are expected to disclose to the program audience (1) any real or apparent conflict(s) of interest related to the content of their presentation and (2) discussion of unlabeled or unapproved uses of drugs or medical devices. Faculty disclosure statements can be found with their biographical sketches.

Conflict of Interest Resolution

When individuals in a position to control or influence the development of the content have reported Financial Relationships with one or more commercial interests, The FCG Institute for Continuing Education utilizes a process to identify and resolve potential conflicts to ensure that the content presented is free of commercial bias. The content of this presentation was vetted through The Institute’s process of peer review and content validation and modified as required to meet this standard.

Notice About Investigational or Off-Label Use

This educational activity may include discussion of drugs or devices or uses of drugs and devices, that have not been approved by the FDA or have been approved by the FDA for specific uses only. It is the responsibility of the physician to determine the FDA clearance status of each drug or device he or she wishes to use in clinical practice. The FCG Institute for Continuing Education is committed to the free exchange of medical education. Inclusion of any product or device discussion, including discussion of investigational or off-label uses, does not imply endorsement by The Institute of the uses, products, or techniques presented.

Disclaimer

This CME/CE activity is designed for use by healthcare professionals for educational purposes only. The information and opinions expressed by the faculty are their own and do not necessarily reflect those of The FCG Institute. The FCG Institute for Continuing Education does not define a standard of care, nor does it intend to dictate an exclusive course of management but presents through the educational activities it sponsors recognized methods and techniques of clinical practice for consideration by physicians and other healthcare providers for incorporation into their practices. Participants should use their own clinical judgment before applying information, whether provided here or by others, for any professional use.

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