Management of persistent intraoperative microvascular bleeding after reversal of anticoagulation following CPB

An institutional goal-directed algorithm is useful to manage persistent microvascular bleeding (defined as bleeding without an apparent surgical site) after cardiac surgery with CPB, and guide appropriate intraoperative transfusion decisions.

This example is based on results of standard laboratory tests. If available, thromboelastography (TEG), thromboelastometry (ROTEM), and other point-of-care tests (eg, platelet function tests) are also checked.*

CPB: cardiopulmonary bypass; ACT: activated whole blood clotting time; aPTT: activated partial thromboplastin time; INR: international normalized ratio; EACA: epsilon-aminocaproic acid; TXA: tranexamic acid; RBCs: red blood cells; FFP: fresh frozen plasma; PCC: prothrombin complex concentrate; IU: international units.

* Refer to UpToDate's content on reversal of anticoagulation after CPB, management of intraoperative bleeding, and transfusion of blood products for detailed discussion.

¶ Refer to UpToDate topics regarding management of hypothermia after CPB and perioperative temperature management.

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Management of persistent intraoperative microvascular bleeding after reversal of anticoagulation following CPB