Hemodilution on Cardiopulmonary Bypass: Thromboelastography Patterns and Coagulation-Related Outcomes

The contribution of the individual blood elements to the variability of thromboelastographic measures

“…But if TEG appears to perform so poorly as a clinical test of coagulation, why does it work well to reduce blood usage in cardiac surgery? The answer would appear to be that TEG provides a signal that something is wrong rather than a specific indication of what is wrong with coagulation . By indicating that coagulation is normal, it leads to a reinspection for surgical causes of bleeding and by indicating coagulation dysfunction, to earlier provision of plasma and PLTs leading to an earlier balanced hemostatic resuscitation with better outcomes…”

Point-of-care coagulation management during surgery with minimal invasive extracorporeal circulation

“…Ranucci et al showed that in the cardiac surgery setting, hemodilution after CPB shifted patients' profiles towards a hypercoagulable state which resulted in a higher rate of bleeding-related events (25). We noticed that the beneficial effect of MiECC due to avoidance of hemodilution and coagulation preservation results in a satisfied clot quality after CPB which is reflected in a very low FFP and platelet transfusion rate.…”

Which Came First, the Chicken or the Egg?—Clinical Dilemmas in Managing Postoperative Bleeding and Decision-making for Re-exploration After Cardiac Surgery

“…Any of these interventions performed to mitigate the harms of bleeding is associated with a worse clinical outcome, 4,5 even increasing postoperative thrombotic complications. 6 It would be ideal for the cause of perioperative coagulopathy to be diagnosed quickly and the most appropriate intervention chosen to fix the problem. However, coagulopathy after cardiac surgery commonly is multifactorial, and the etiology of bleeding is often difficult to determine.…”