Keywords
Key points
- •Bleeding and transfusion in cardiac surgery are common and associated with poorer outcomes.
- •Hemostasis in cardiac surgery with cardiopulmonary bypass is complex and influenced by major surgical trauma, cardiopulmonary bypass–associated coagulopathy, anticoagulation management, and additional perioperative factors.
- •Patient blood management aims to improve outcomes by the prediction, prevention, monitoring, and treatment of bleeding and transfusion.
- •Patient blood management includes many options to improve outcome and should be combined in a multidisciplinary approach.
Introduction

Pathophysiology of coagulopathy in cardiac surgery

- •Major surgical trauma
- ○Sternotomy
- ○Venesection
- ○Arterial and venous cannulation
- ○
- •CPB-associated coagulopathy
- ○Consumptive coagulopathy
- ○(Hyper)fibrinolysis
- ○
- •Anticoagulation management
- ○Heparin
- ○Protamine
- ○
- •Additional perioperative factors
- ○Acidosis
- ○Hemodilution
- ○Hypocalcemia
- ○Hypothermia
- ○
Patient blood management

Prediction
Risk scores
Hemostasis testing for prediction
Prevention of Transfusion
Treatment of preoperative anemia
Cell salvage
Autologous (pre)donation
Transfusion trigger
Prevention of Coagulopathy
Stop anticoagulation
Antifibrinolytics
Available at: https://www.ema.europa.eu/en/medicines/human/referrals/antifibrinolytic-medicines. Accessed December, 2018.
Acute normovolemic hemodilution
Anticoagulation during cardiopulmonary bypass
Protamine dosing
Monitoring

Treatment
Platelet concentrate
Coagulation factor replenishment
Miscellaneous
Summary
References
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Disclosure Statement: M.I. Meesters does not have any disclosures. C. von Heymann discloses that he has received honoraria for lectures and consultancy work, travel reimbursements and research grants related to the topic of this article from CSL Behring, Novo Nordisk, Ferring GmbH, and Shire over the last 3 years.
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