Antithrombotic therapy management of adult and pediatric cardiac surgery patients

Journal of Thrombosis and Haemostasis : JTH
L Baumann KreuzigerM P Massicotte

Abstract

Despite the development of catheter-based interventions for ischemic and valvular heart disease, hundreds of thousands of people undergo open heart surgery annually for coronary artery bypass graft (CABG), valve replacement or cardiac assist device implantation. Cardiac surgery patients are unique because therapeutic anticoagulation is required during cardiopulmonary bypass. Developmental hemostasis and altered drug metabolism affect management in children. This narrative review summarizes the current evidence-based and consensus guidelines regarding perioperative, intraoperative and postoperative antithrombotic therapy in patients undergoing cardiac surgery. Anticoagulation preoperatively is required in the setting of cardiac arrhythmias, prior valve replacement or history of venous thromboembolism. In patients with ischemic heart disease, aspirin is continued in the perioperative period, whereas oral P2Y12 antagonists are withheld for 5-7 days to reduce the risk of perioperative bleeding. Intraoperative management of cardiopulmonary bypass in adults and children includes anticoagulation with unfractionated heparin. Variability in dose-response to heparin and influence of other medical conditions on dosing and reversal of hepa...Continue Reading

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Apr 2, 2019·Anaesthesia·L T S HoUNKNOWN transfusion avoidance in cardiac surgery study investigators
Jun 12, 2020·World Journal of Gastroenterology : WJG·Srikanth VedachalamSomashekar G Krishna
Dec 1, 2020·Journal of Thrombosis and Haemostasis : JTH·Justyna Bartoszko, Keyvan Karkouti
Mar 19, 2021·Frontiers in Pediatrics·Muhammad Bakr GhbeisRavi Ram Thiagarajan
Aug 27, 2021·The Annals of Thoracic Surgery·Austin L RogersShahab A Akhter

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