Practical Management of Anticoagulation, Bleeding and Blood Product Support for Cardiac Surgery Part One: Bleeding and Anticoagulation Issues
Kathryn L. Robinson MB BS, FRACP,
Silvana F. Marasco MB BS, FRACS, Alison M. Street MB BS, FRACP,
Kathryn L. Robinson MB BS, FRACP
Australian Red Cross Blood Service, Adelaide, South Australia,
Search for more papers by this authorAlison M. Street MB BS, FRACP
Haematology Unit, The Alfred Hospital, Melbourne, Victoria, Australia
Search for more papers by this authorKathryn L. Robinson MB BS, FRACP,
Silvana F. Marasco MB BS, FRACS, Alison M. Street MB BS, FRACP,
Kathryn L. Robinson MB BS, FRACP
Australian Red Cross Blood Service, Adelaide, South Australia,
Search for more papers by this authorAlison M. Street MB BS, FRACP
Haematology Unit, The Alfred Hospital, Melbourne, Victoria, Australia
Search for more papers by this author
Correspondence:
Alison M. Street,
Haematology Unit, The Alfred Hospital, PO Box 315, Prahran, Victoria 3181, Australia. Email: [email protected]
Abstract
There are many challenging problems related to bleeding and anticoagulation in cardiac surgery. Practical guidelines, which are based on available evidence, can help to direct management issues of post-bypass bleeding, perioperative anticoagulation and the use of haemostatic agents. The patient’s bleeding history is the most useful preoperative screening test of haemostasis. The input of a haematologist is often valuable in a number of areas, such as preoperative assessment of patients with a significant history of bleeding, or past history of heparin-induced thrombocytopenia, a lupus anticoagulant, or recent venous thromboembolism. Cardiothoracic surgeons, anaesthetists, perfusionists and haematologists can ensure ‘best practice’ by being actively involved in the development of ‘local’ transfusion and anticoagulation guidelines, hospital transfusion committee policies, and audits. (Heart, Lung and Circulation 2001; 10: 142–153)
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