Pathophysiology, prevention, and treatment of bleeding after cardiac surgery: a primer for cardiologists and an update for the cardiothoracic team

Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at increased risk for excessive perioperative blood loss requiring transfusion of blood products. The risk is dependent on the status of the patient, the type of procedure, and the duration of CPB. This brief review will summarize (1) the pathophysiology of abnormalities in the hemostatic system during CPB; (2) important pharmacologic interventions currently available to decrease blood loss, including mechanisms by which these agents lead to preservation of hemostasis during CPB; and (3) the optimal management of perioperative bleeding using point-of-care coagulation tests.