Managing bleeding patients in cardiac surgery is a unique and constantly evolving challenge. Increasingly more complex procedures associated with predictable and sometimes unpredictable bleeding are performed. This is further compounded by increased use of mechanical perfusion devices that require anticoagulation, or just a general increase in the use of potent antiplatelet agents (sometimes with unpredictable effect) or newer classes of anticoagulants. Transfusion algorithms can be useful, but given the dynamic environment, the time it takes to obtain coagulation results, order appropriate products and administer them may be too long, forcing clinicians to rely on intuition and empiric treatment. It can be challenging to distinguish between surgical bleeding and coagulopathy.
How best to manage clinical bleeding through targeted blood product utilization remains controversial. To assist with complex decision-making, there is a rapidly expanding market for user friendly point of care (POC) coagulation monitors. But despite bold marketing, they are not widely available and their clinical impact at this stage is uncertain. In addition, although perioperative therapies (such as factor concentrates) are having a major impact in rapidly reversing severe coagulopathy, some carry a risk for arterial and venous thrombotic complications and there are no clear guidelines on their use in cardiac surgery.
Of the three speakers in this session, one will be a transfusion medicine specialist addressing specific issues in blood product ordering and utilization in cardiac surgery; the second, a cardiac anesthesiologist who will discuss challenges in the operating room in mediating decisions about laboratory test results and ordering of blood products; the third will be specialist in coagulation and point of care (POC) testing.
Debate the major decisional challenges in managing bleeding in the operating room in cardiac surgery.
Discuss controversies in blood product utilization and perioperative therapies in cardiac surgery.
Assess challenges in point of care coagulation testing in cardiac surgery.
MD, PhD, MPH, MFA, MMHC, JD, FCAP, FASCP,
Professor of Pathology & Medical Education, Co-Director, Transfusion Medicine,