Anticoagulation protocols for minimized cardiopulmonary bypass

The possible changes to the routine anticoagulation management that can be applied when using a mini-cardiopulmonary bypass circuit are described in this chapter. Mini-cardiopulmonary bypass circuits usually enable the reinfusion of shed blood to be avoided during the cardiac operation. Shed blood is the main source of tissue factor, which is in turn the major determinant of thrombin generation. Therefore, mini-cardiopulmonary bypass circuits may limit thrombin generation and consequently the need for large doses of heparin. Protocols based on reduction of systemic heparinization with specific monitoring of the anticoagulation are discussed.