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Understanding and managing the complex balance between bleeding and thrombosis following cardiopulmonary bypass in paediatric cardiac surgical patients

Part of: Surgery Hypoplastic Left Heart Syndrome (HLHS)

Published online by Cambridge University Press:  24 May 2021

Jordan A. Cohen Open the ORCID record for Jordan A. Cohen [Opens in a new window] ,
David Faraoni  and
David F. Vener
Jordan A. Cohen*
Affiliation:
Department of Anesthesia, University of Miami, Miller School of Medicine, Miami, FL, USA
David Faraoni
Affiliation:
The Hospital for Sick Children, Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, Canada
David F. Vener
Affiliation:
Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
*
Author for correspondence: Dr J. A. Cohen, BS, Department of Anesthesia, University of Miami, Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL33136, USA. Tel: +602 350 6118; Fax: 305-545-6501. E-mail: jac617@med.miami.edu
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Abstract

Bleeding in the perioperative period of congenital heart surgery with cardiopulmonary bypass is associated with increased morbidity and mortality both from the direct effects of haemorrhage as well as the therapies deployed to restore haemostasis. Perioperative bleeding is complex and multifactorial with both patient and procedural contributions. Moreover, neonates and infants are especially at risk. The objective of this review is to summarise the evidence regarding bleeding management in paediatric surgical patients and identify strategies that might facilitate appropriate bleeding management while minimising the risk of thrombosis. We will address the use of standard and point-of-care tests, and the role of contemporary coagulation factors and other novel drugs.

Keywords

Paediatric cardiac surgeryanaesthesiableedingthrombosispoint-of-care testing
Type
Review
Information
Cardiology in the Young , Volume 31 , Issue 8 , August 2021 , pp. 1251 - 1257
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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