Perioperative coagulation in cardiovascular surgery

The evolution of scientific knowledge in cardiac surgery and cardiopulmonary bypass has enabled the reduction of perioperative complications, despite an increase in patient-related risks and in the complexity of surgical procedures. However, the management of hemostasis and coagulation remains a difficult issue, and it is of note that the rates of allogeneic blood transfusion and surgical revision in bleeding patients have not declined in recent years. The perioperative coagulopathy in patients undergoing cardiac surgical procedures is a highly complex and challenging field, and appropriate management is essential to improve morbidity and mortality. Identifying the patient’s preoperative hemorrhagic risk factors and understanding the mechanisms involved in coagulopathy and fibrinolysis during cardiopulmonary bypass are crucial for the patient’s care. Today, the use of practice guidelines and point-of-care testing is an established part of the management of the bleeding patient. In this chapter, we review the state of knowledge on perioperative hemostasis management in cardiac surgery and describe some specific points on the pathophysiology and pharmacology of CPB-related coagulopathies.