Coagulation monitoring

Abstract

Hemorrhage is a common problem during and after pediatric cardiac surgery that challenges surgeons and anesthesiologist. Young age, low weight, polycythemia, deep hypothermia, and complex cardiac surgery are risk factors for severe bleeding. In addition we need to take into account the growing use of drugs that affect platelet aggregation and coagulation which if not managed correctly could increase the bleeding risk. Point-of-care (POC) testing allows to monitor one of the most worrisome aspects that concern the healthcare providers when faced to surgical procedure, the hemostasis. POC is a global test done on whole blood, which allows bedside testing (either in the operating room or the intensive care) of coagulopathy of diverse ethology. The use of POC testing is integrated in evidence-based algorithms as one of the important mechanisms to limit blood product exposure, avoiding transfusion-related adverse events. POC-based algorithms allow goal-directed therapy of blood products and targeted factor concentrate substitutions.