*Corresponding author:Luděk Slavík, Department of Cardiac Surgery, Republic of Czech
Received: June 18, 2018; Published: June 28, 2018
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Cardiopulmonary bypass (CPB) is associated with common activation of all four integral components of hemostasis, that is, the endothelium, plasma proteins, platelets and fibrinolysis. The causative factors include the presence of an artificial non-endothelial surface of the CPB system, non-pulsatile blood flow, hemodilution, hypothermia, surgical trauma and a systemic inflammatory response to CPB. Microthrombi formation, coagulation defects and hypercoagulability in the postoperative period may occur. The key pathway of activation is platelet binding to collagen via von Willebrand factor, platelet activation and aggregation and formation of an initial hemostatic plug. Thrombin generation (tF+fVIIa →fIXa →fXa →prothrombin →thrombin) activates platelets, fV, fVIII and fXI. Fibrinogen and fXIII stabilize the clot.
Keywords: Fibrinolysis; Hypothermia; Hypercoagulability; Non-Pulsatile; Hemostasis; Hemodilution; Trauma; Coagulation; Thrombocytopenia; Hemostatic Plug
Abbreviations: CPB: Cardiopulmonary Bypass; PRP: Platelet Rich Plasma; UFH: Unfractionated Heparin; ACT: Activated Coagulation Time; RBC: Red Blood Cell; TEG: Thrombo Elasto Graphy; LTA: Light Transmission Aggregometry; PPP: Platelet Poor Plasma