Perioperative Coagulation Management of a Hemophilia A Patient During Cardiac Surgery

Document Type

Journal Article

Publication Date

12-1-2017

Journal

Seminars in Cardiothoracic and Vascular Anesthesia

Volume

21

Issue

4

DOI

10.1177/1089253217702747

Keywords

cardiac surgery; cardiopulmonary bypass; coagulation monitoring; factor VIII; hemodilution; hemophilia A

Abstract

Perioperative management of cardiovascular surgical procedures requiring cardiopulmonary bypass (CPB) in patients with hemophilia A poses a clinical challenge in coagulation management. Use of CPB requires the administration of an anticoagulant, usually unfractionated heparin, and also causes dilutional coagulopathy, platelet dysfunction or platelet consumption coagulopathy. Hypothermia and activation of the inflammatory cascade also affect coagulation. The effects of CPB on circulating levels of factor VIII have not been clearly defined. In this review, the effects of CPB and hemodilution on FVIII are shown in a case presentation, and perioperative laboratory testing in patients with hemophilia A having cardiac surgery is discussed along with perioperative and postoperative coagulation management.

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