HEMOSTASIS IN AORTIC AND CARDIOTHORACIC SURGERY

Hemostasis abnormalities in cardiovascular and aortic surgery remain a major source of morbidity and mortality in patients undergoing such c omplex procedures. The need for frequent transfusions of red cell and other blood products increases risks and costs to patients and institu tions providing patient care. Specifically in cardiovascular and aorti c surgery, the nature of the surgery is, at best, semi-elective, and c areful preparation to preserve the hemostatic mechanisms of the body i s essential. Contact of blood with the extracorporeal circuit induces a hemorrhagic diathesis through a variety of different mechanisms. Dil ution of the patient's blood volume by the extracorporeal circuit prim e causes depletion of platelets and coagulation factor levels. Aorto i ntimal disease initiates fibrinolysis by the release of tissue plasmin ogen activator. Due to the numerous etiologies of bleeding, a combinat ion of blood conservation strategies is suggested. The ideal combinati on of interventions has yet to be determined and is currently dependen t on patient variables, physician and institutional practices, and eco nomic pressures.