Comprehensive Coagulation Management in Cardiac Surgery: Anticoagulants, Heparin Resistance, Monitoring, and Bleeding Risks : Coagulation Management in Cardiac Surgery.
Research article published in Galen medical journal (2025)
Abstract
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.
Resumen
Comprehensive Coagulation Management in Cardiac Surgery: Anticoagulants, Heparin Resistance, Monitoring, and Bleeding Risks : Coagulation Management in Cardiac Surgery.
Por qué esto importa para la hirudoterapia
Esta revisión integral examina la gestión de la coagulación en cirugía cardíaca, describiendo la heparina no fraccionada como el estándar para la anticoagulación en bypass cardiopulmonar (notando la resistencia persistente a la heparina), alternativas como las heparinas de bajo peso molecular, inhibidores directos de la trombina y anticoagulantes orales nuevos para indicaciones seleccionadas, herramientas de monitoreo (ACT, pruebas de anti-factor Xa y pruebas viscoelásticas como TEG/ROTEM), y direcciones emergentes que incluyen inhibidores del factor XI y predicción de sangrado basada en IA. Para la ASH es un contexto útil porque mapea el terreno de la anticoagulación clínica y el monitoreo hemostático en el que se utilizan y miden los inhibidores directos de la trombina —la clase farmacológica a la que pertenece el anticoagulante derivado de lombriz hirudina y sus descendientes sintéticos (por ejemplo, bivalirudina, lepirudina)—. Como una revisión narrativa que resume estrategias existentes en lugar de informar nuevos datos, proporciona un marco y no establece por sí mismo ninguna afirmación relacionada con sanguijuelas o eficacia comparativa; también no aborda la hirudoterapia directamente.
Citación
Comprehensive Coagulation Management in Cardiac Surgery: Anticoagulants, Heparin Resistance, Monitoring, and Bleeding Risks : Coagulation Management in Cardiac Surgery.
Negargar et al. · Galen medical journal, 2025
Contexto clínico relacionado
Explore cómo esta investigación se conecta con la práctica clínica
Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026