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Chapter 1:
Hemostasis and Why We Care About It in
Cardiopulmonary Bypass Surgery
Overview
Cardiopulmonary bypass surgery degrades hemostasis. There are multiple contributing factors to this
degradation. Heparin is added to inhibit coagulation; blood volume is diluted; coagulation factors and
platelets are activated by bypass circuits and surgical trauma; heparin is reversed with protamine restoring
coagulation; and bleeding depletes clotting factors and platelets.
During bypass, inadequate anticoagulation elevates thrombotic risks. Excessive anticoagulation potentially
impairs hemostasis restoration. Accurate anticoagulation management reduces both thrombotic risk
during bypass and potential bleeding complications after bypass.
Post bypass, hemostasis may be impaired by loss of clotting factors or platelets, residual heparin, or
excessive uncorrected vascular damage. Blood component therapy may be necessary to control bleeding,
but unnecessary use of blood products should be avoided.
Hemostasis performance and clinical management affect patient outcomes and treatment costs. Effective
and comprehensive hemostasis management is one important component of cardiopulmonary bypass
surgery.
Hemostasis Management Testing Needs
Cardiopulmonary bypass surgery teams need to manage heparin administration, neutralize heparin,
and resolve bleeding complications. The specific requirements for hemostasis management throughout
cardiopulmonary bypass surgery may include: pre-surgical screening for potential existing coagulopathies,
verification of adequate anticoagulant therapy prior to bypass, management of anticoagulant therapy
during bypass, and comprehensive hemostasis assessment post bypass and throughout recovery.
Technology trends are moving more advanced instruments into the operating room offering comprehensive
test results of coagulation assessment, platelet function, and overall hemostasis performance with point-
of-care convenience.
Hemostasis Management and the Sonoclot Analyzer
The Sonoclot Analyzer is a sensitive instrument designed to detect and quantify viscoelastic changes in a
whole blood sample that occur throughout hemostasis. Hemostasis testing with the Sonoclot Analyzer has
evolved to address multiple needs of cardiopulmonary bypass surgery including both anticoagulation and
bleeding management. The Sonoclot Analyzer product line is the only integrated solution that addresses
both convenient and cost effective anticoagulation management with global hemostasis monitoring for
managing clinical bleeding.
