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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Woodman, R. C. Articles by Harker, L. A. Search for Related Content PubMed PubMed Citation Articles by Woodman, R. C. Articles by Harker, L. A. Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Bleeding complications associated with cardiopulmonary bypass RC Woodman and LA Harker Department of Molecular and Experimental Medicine, Research Institute of Scripps Clinic, La Jolla, CA. Bleeding after CPB has been difficult to characterize and its treatment equally difficult to standardize. The complexity of this problem is related to the hemostatic process, the technical variations in the operative procedures, and the many uncontrolled variables associated with CPB, including the effects of anesthetic or pharmacologic agents, the nature of the priming solution, hemodilution, hypothermia, the type of oxygenator, and the use of transfused blood products. Although there are multiple and generally predictable complex changes in the hemostatic mechanism during CPB, the temporary loss of platelet function is the most common and clinically relevant. This transient platelet dysfunction occurs in all patients undergoing CPB; however, it only causes excessive bleeding in a small percentage of patients. Unfortunately, it has not yet been possible to predict which patients will develop hemorrhagic complications, although prolonged pump times are a contributing risk factor. Over the past decade there has been extensive investigation into the management of bleeding associated with CPB, provoked primarily by the increased awareness of transfusion- transmitted viral diseases and the inappropriately excessive use of homologous blood products. Several approaches to autotransfusion of shed blood and autologus blood donation have been developed to minimize perioperative homologous blood transfusion. Pharmacologic agents such as desmopressin, aprotinin, and topical fibrin glues have also been introduced to improve hemostasis during CPB. The protease inhibitor aprotinin is particularly promising in the reduction of bleeding associated with CPB when given prophylactically. Aprotinin may provide new insights into the mechanism of CPB-induced platelet dysfunction. Desmopressin is indicated only for the treatment of bleeding after CPB. The management of bleeding associated with CPB will undoubtedly Volume 76, Issue 9, pp. 1680-1697, 11/01/1990 Copyright © 1990 by The American Society of Hematology CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: L. J. Enriquez and L. Shore-Lesserson Point-of-care coagulation testing and transfusion algorithms Br. J. Anaesth., December 1, 2009; 103(suppl_1): i14 - i22. [Abstract] [Full Text] [PDF] K. Nardell, G. M Annich, J. C Hirsch, C. Fahrner, P. Brownlee, K. King, G. M Fleming, and R. J Gajarski Risk factors for bleeding in pediatric post-cardiotomy patients requiring ECLS Perfusion, May 1, 2009; 24(3): 191 - 197. [Abstract] [PDF] G. Mannam, L. R Sajja, S. B. Dandu, S. N Pathuri, K. V. Saikiran, and S. Sompalli Off-Pump Coronary Revascularization for Left Main Coronary Artery Stenosis Asian Cardiovasc Thorac Ann, December 1, 2008; 16(6): 473 - 478. [Abstract] [Full Text] [PDF] A. M. Mengistu, K. D. 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[Abstract] [Full Text] S. F. Khuri, C. R. Valeri, J. Loscalzo, M. J. Weinstein, V. Birjiniuk, N. A. Healey, H. MacGregor, M. Doursounian, and M. A. Zolkewitz Heparin Causes Platelet Dysfunction and Induces Fibrinolysis Before Cardiopulmonary Bypass Ann. Thorac. Surg., October 1, 1995; 60(4): 1008 - 1014. [Abstract] [Full Text] B. Liu, L. Tengborn, G. Larson, L. O. G. Radberg, A. Belboul, L. Dernevik, and D. Roberts Half-Dose Aprotinin Preserves Hemostatic Function in Patients Undergoing Bypass Operations Ann. Thorac. Surg., June 1, 1995; 59(6): 1534 - 1540. [Abstract] [Full Text] J. P. A. M. Schonberger, P. A. M. Everts, and J. J. Hoffmann Systemic Blood Activation With Open and Closed Venous Reservoirs Ann. Thorac. Surg., June 1, 1995; 59(6): 1549 - 1555. [Abstract] [Full Text] H. P. Wendel, W. Heller, J. Michel, G. Mayer, C. Ochsenfahrt, U. Graeter, J. Schulze, H.-M. Hoffmeister, and H.-E. Hoffmeister Lower cardiac troponin T levels in patients undergoing cardiopulmonary bypass and receiving high-dose aprotinin therapy indicate reduction of perioperative myocardial damage J. Thorac. Cardiovasc. Surg., June 1, 1995; 109(6): 1164 - 1172. [Abstract] [Full Text] J. E. Tcheng, R. A. Harrington, K. Kottke-Marchant, N. S. Kleiman, S. G. Ellis, D. J. Kereiakes, M. J. Mick, F. I. Navetta, J. E. Smith, S. J. Worley, et al. Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial of the Platelet Integrin Glycoprotein IIb/IIIa Blocker Integrelin in Elective Coronary Intervention Circulation, April 15, 1995; 91(8): 2151 - 2157. [Abstract] [Full Text] A. Shinfeld, D. Zippel, J. Lavee, A. Lusky, E. Shinar, N. Savion, and R. Mohr Aprotinin Improves Hemostasis After Cardiopulmonary Bypass Better Than Single-Donor Platelet Concentrate Ann. Thorac. Surg., April 1, 1995; 59(4): 872 - 876. 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