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.
Резюме
Comprehensive Coagulation Management in Cardiac Surgery: Anticoagulants, Heparin Resistance, Monitoring, and Bleeding Risks : Coagulation Management in Cardiac Surgery.
Почему это важно для гирудотерапии
Этот всесторонний обзор рассматривает управление коагуляцией в кардиохирургии, описывая нефракционированный heparin как стандарт антикоагуляции при искусственном кровообращении (отмечая устойчивую резистентность к heparin), такие альтернативы, как низкомолекулярные heparin, прямые ингибиторы тромбина и новые пероральные антикоагулянты для отдельных показаний, средства мониторинга (ACT, определение анти-Factor Xa и вискоэластические тесты, такие как TEG/ROTEM), а также новые направления, включая ингибиторы фактора XI и прогнозирование кровотечений на основе ИИ. Для ASH это полезный контекст, поскольку он картирует клинический антикоагулянтный и гемостатически-мониторинговый ландшафт, в котором применяются и измеряются прямые ингибиторы тромбина — класс препаратов, к которому относятся полученный из пиявки антикоагулянт hirudin и его синтетические производные (например, bivalirudin, lepirudin). Будучи повествовательным обзором, обобщающим существующие стратегии, а не сообщающим новые данные, он предоставляет обрамление и сам по себе не устанавливает никаких утверждений, связанных с пиявками, или утверждений о сравнительной эффективности; он также не рассматривает гирудотерапию напрямую.
Цитирование
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
Связанный клинический контекст
Узнайте, как это исследование связано с клинической практикой
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