Cardiac surgery is unique in using cardiopulmonary bypass in various clinical scenarios. Injury of vital organs is unavoidable in the perioperative period. Acute kidney injury is a consequence of the systemic inflammatory response after bypass, emboli, ischemia, and low cardiac output states, reportedly occurring in 30%-40% of open heart surgeries. Acute kidney injury is associated with increased morbidity, mortality, and cost. Many preventive measures (off-pump procedures, decreased crossclamp time, pulsatile flow, adequate hydration) are taken in the perioperative period to avoid organ injury, but in vain. Traditionally, blood urea, serum creatinine, and creatinine clearance rate were applied for prediction of acute kidney injury. The recent emergence of biomarkers such as neutrophil gelatinase-associated lipocalin, cystatin C, liver-type fatty acid binding protein, interleukin-18, kidney injury molecule-1, and tetrahydrobiopterin have helped in detecting acute kidney injury long before the rise of serum creatinine. These biomarkers can also be used as tools for predicting therapeutic effects in acute kidney injury and for monitoring drug toxicity. This review consolidates the knowledge of biomarkers and their application in acute kidney injury management.

Intracranial haemorrhage (ICH) is a dreaded complication caused by oral anticoagulants (OAC) after valvular heart surgeries. Anticoagulant use in conventional doses increases the risk of ICH 7-10 fold. Intracerebral haematomas constitute 70% of the anticoagulant-related intracranial haemorrhages, with mortalities approaching 60%. Predisposing factors for anticoagulant-related ICH in Indian patients are unique as compared to those seen in their western counterparts. In anticoagulated patients, ICH evolves rapidly within hours; hence, emergency reversal of anticoagulation is crucial. We are reporting four cases of cerebral strokes which followed valvular surgeries in our institution, who were admitted during August 2012 to July 2013. There is an increasing need to educate the patients and update the physicians regarding the various issues which are involved in anticoagulation management.