Comprehensive Coagulation Management in Cardiac Surgery: Anticoagulants, Heparin Resistance, Monitoring, and Bleeding Risks : Coagulation Management in Cardiac Surgery.

Effective coagulation management is pivotal to optimizing outcomes in cardiac surgery, influencing bleeding risk, transfusion requirements, and overall perioperative safety. This comprehensive review examines current strategies, limitations, and emerging innovations across anticoagulant use, coagulation monitoring, and bleeding management. Unfractionated heparin remains the standard for cardiopulmonary bypass (CPB) anticoagulation, owing to its rapid reversibility, though challenges such as heparin resistance persist. Alternatives including low molecular weight heparins, direct thrombin inhibitors, and novel oral anticoagulants are reserved for select indications and carry specific limitations. Perioperative coagulation monitoring is essential; tools such as activated clotting time (ACT), anti-factor Xa assays, and viscoelastic tests (e.g., thromboelastography [TEG] and rotational thromboelastometry [ROTEM]) guide targeted therapy. Despite these advances, bleeding remains common due to factors including preoperative antithrombotic therapy, CPB-induced coagulopathy, and postoperative hemostatic deficits. Management strategies center on prophylactic antifibrinolytics, individualized transfusion protocols, and the judicious use of reversal agents. Emerging frontiers including machine learning-enhanced viscoelastic algorithms, targeted antithrombotics (e.g., factor XI inhibitors), AI-based bleeding prediction, and gene therapy for inherited coagulopathies promise to personalize and improve care. Continued research is warranted to validate novel therapies and refine evidence-based protocols for coagulation management in cardiac surgery. Effective coagulation management is pivotal to optimizing outcomes in cardiac surgery, influencing bleeding risk, transfusion requirements, and overall perioperative safety. This comprehensive review examines current strategies, limitations, and emerging innovations across anticoagulant use, coagulation monitoring, and bleeding management. Unfractionated heparin remains the standard for cardiopulmonary bypass (CPB) anticoagulation, owing to its rapid reversibility, though challenges such as heparin resistance persist. Alternatives including low molecular weight heparins, direct thrombin inhibitors, and novel oral anticoagulants are reserved for select indications and carry specific limitations. Perioperative coagulation monitoring is essential; tools such as activated clotting time (ACT), anti-factor Xa assays, and viscoelastic tests (e.g., thromboelastography [TEG] and rotational thromboelastometry [ROTEM]) guide targeted therapy. Despite these advances, bleeding remains common due to factors including preoperative antithrombotic therapy, CPB-induced coagulopathy, and postoperative hemostatic deficits. Management strategies center on prophylactic antifibrinolytics, individualized transfusion protocols, and the judicious use of reversal agents. Emerging frontiers including machine learning–enhanced viscoelastic algorithms, targeted antithrombotics (e.g., factor XI inhibitors), AI-based bleeding prediction, and gene therapy for inherited coagulopathies promise to personalize and improve care. Continued research is warranted to validate novel therapies and refine evidence-based protocols for coagulation management in cardiac surgery.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Comprehensive Coagulation Management in Cardiac Surgery: Anticoagulants, Heparin Resistance, Monitoring, and Bleeding Risks : Coagulation Management in Cardiac Surgery.

Erfahren Sie, wie diese Forschung mit der klinischen Praxis verknüpft ist

More peer-reviewed studies in Klinische Studien.

• Leech Therapy for Knee Osteoarthritis — The Landmark RCT — Michalsen et al. (2003)
• Leech-Assisted Flap Salvage — Systematic Review of 277 Cases — Whitaker et al. (2012)
• Effects of hirudotherapy on liver functions, lipid profile, and insulin sensitivity in rats with metabolic syndrome — Bilden A et al. (2026)
• HIRUDOTHERAPY IN PRESBYACUZIS PRAECOX IN CLEAN-UP WORKERS AFTER THE CHORNOBYL ACCIDENT DURING THE POST-CATASTROPHE YEARS — Zabolotnyi D, Mishchanchuk N (2019)
• Wound healing potential of bark paste of Pongamia pinnata along with hirudotherapy: A case report — Balasooriya D, Karunarathna C, Uluwaduge I (2021)
• AIF-1 and RNASET2 Play Complementary Roles in the Innate Immune Response of Medicinal Leech — Baranzini N et al. (2019)
• Study on the effect of medicinal leech therapy (Hirudo medicinalis) on full-thickness excisional wound healing in the animal model — Zakian A et al. (2022)
• [Hirudo medicinalis-leech applications in plastic and reconstructive microsurgery--a literature review] — Knobloch K et al. (2007)
• The duration of rest and feeding greatly affects the re-breeding of ectoparasites: Hirudo verbana, Hirudo medicinalis and Hirudo orientalis — Aminov R, Frolov A, Aminova A (2022)
• Recombinant hirudin in clinical practice: focus on lepirudin — Greinacher A, Lubenow N (2001)

Browse all ASH-analysed research →