Factor X Inhibition? Cardiac Health Supplements / Polyphenol Compounds & Considerations Regarding Hemostasis…

Editor’s Note:   Had an unusual presentation of unexpected post op bleeding the other day with a patient that had no concomitant coagulation issues nor other co-existing disease states that would possibly contribute or amplify post CPB hemostasis. Normally I would write this off as the “the less-than-extraordinary transcendence of damage to general hemostasis” that […]

Perfusion Policies 101: Anticoagulation Reversal

Renee Toth, BS, CCP   Editor’s Note: Renee is a colleague I work with quite often.  She is an amazing perfusionist as well as administrator, mom, and just a decent all around human being. She has a pretty scathing wit- so beware.  She offered to share a policy she has worked on for a quite […]

Perfusion Policies 101: Cold Agglutinins

Editor’s Note: PERFUSION POLICIES 101 Welcome to PERFUSION POLICIES 101.  This will be a continuing series provided to assist your programs with that one puzzle piece we all run into now and then- that one time that an unexpected patient condition may give you pause… The intention here is to disseminate some basic recipes that […]

Why is my Patient Bleeding? A Snapshot of Hemostasis, Part II

Click on image to view source article Editor’s Note: We have all revisted this pathway intensively throughout our careers, and of course, we have all been clinically challenged by open-heart cases that test our fundamental understanding of coagulation theory in real time, at a level that certainly reflects a fairly deep dive into esoteric hematology. So i am keeping it simple, and found […]

Perfusion Policies 101: Angiomax

Editor’s Note: The use of alternatives to heparin in terms of managing anicoagulation doesn’t come up often.  It’s easy to get a bit rusty when it comes to using exotic agents such as Ancrod (Hirudin), Angiomax and similar agents. So here is a brief refresher, and as always- a disclaimer here:  Use this information with […]

Desmospressin: A Primer on DDAVP

<img class="alignnone size-full wp-image-32561" src="https://i2.wp.com/circuit.perfusion.com/wp-content/uploads/2016/07/1 20 mg prednisone.jpg?resize=529%2C167″ alt=”1″ srcset=”https://i2.wp.com/circuit.perfusion.com/wp-content/uploads/2016/07/1.jpg?w=787 787w, https://i2.wp.com/circuit.perfusion.com/wp-content/uploads/2016/07/1.jpg?resize=300%2C95 300w, https://i2.wp.com/circuit.perfusion.com/wp-content/uploads/2016/07/1.jpg?resize=768%2C243 768w” sizes=”(max-width: 529px) 100vw, 529px” data-recalc-dims=”1″ /> Click on image to view source article = Desmopressin Desmopressin acetate (DDAVP) is a synthetic analog of vasopressin and like ADH, epinephrine, and insulin, releases a variety of hemostatically active substances from vascular endothelium.  […]

TEG vs ROTEM? A Brief Comparison AND a Survey?

Click image above to take ROTEM Survey 🙂 Editor’s Note: I was asked by a reader to do an article on thromboelastograms.  Wasn’t sure what approach to take in this regards so decided to do a brief intro and switch the focus in particular to a comparison and differentiation between the two prevalent systems, the TEG and the […]

Angiomax: Use and Dosing Regimen

Editor’s Note: The use of alternatives to heparin in terms of managing anicoagulation doesn’t come up often.  So many of us get a bit rusty when it comes to using exotic agents such as Ancrod (Hirudin), Angiomax and similar agents. So here is a brief refresher, and as always- a disclaimer here:  Use this information […]

Cairo, Egypt: Case Study: AVR with Antiphospholipid Syndrome

Editor’s Note: I saw this post of Ramy’s FB page (or maybe one of the perfusion groups on FB) and reached out to Ramy to submit this as a case study.  He has graciously forwarded the case study and I thank you Ramy. Feel free to leave comments in the comments section- Happy Saturday 🙂 […]

Protamine

Protamine Protamine, a polycationic protein derived from salmon milt, possess strong alkalinity because of an amino acid composition consisting of 67% arginine.  In its natural state, the numerous positive charges on the protamine molecule bind with the negatively charged phosphate groups of the nucleoprotein material of salmon sperm.  Heparin, a polyanion, binds ionically to protamine […]

The TEG (Thromboelastogram)

Editor’s Note: Recently we began employing the TEG routinely for all of our open-heart procedures.  Now I am relatively familiar with the concept, having discussed and written about it before.  However there is an array of numbers and categories that come with the TEG analysis that I wasn’t certain about, so to clear it up […]

AT3 Deficiency

Antithrombin III (AT III) is a plasma glycoprotein with a molecular weight of 58,000 daltons.  AT III deficiency may be noticed when the patient’s activated clotting time (ACT) does not respond to heparin administration as would be expected when given a standard dosage.  Also can be confirmed by a laboratory value of the patient’s AT […]

Cold Agglutinins

Literature: Click image to view source article Cold Agglutinins in Cardiac Surgery: Management of Myocardial Protection and Cardiopulmonary Bypass CAs are autoantibodies to RBC antigens [3], which can causesystemic thrombosis and hemolysis. The cause of these CAs maybe primary/idiopathic, or more commonly, secondary to an infectiveprocess (eg, mycoplasma, human immunodeficiency virus) or alymphoproliferative disorder [2]. […]

On CPB- Heparin Protocol Survey

Editor’s Note: I received a note from a perfusionist the other day regarding heparin administration, and how it has become regulated at their institution.  It was significant enough- in terms of it’s implications of our ability to manage patients on bypass for me to pass on the concern, and as well- develop a survey to […]

Heparin: Factors Affecting & it’s Effects [Reprint]

HEPARIN ONSET: Maximal at 1 minute past atrial delivery: Measured at radial artery.  Note:  10-20% reduction in svr without affecting c.o. and or h.r. LUNG VS MUCOSAL: Mucosal requires larger doses- but can be reversed with 25-30% less protamine:  greater postoperative blood loss associated with mucosal heparin- speculated to result from lower molecular weight & […]

Coagulation Issues: Fibrinolysis & HIT: Helpful Graphics

Fibrinolysis Fibrinolysis is the dissolution of the clot formation process involving the plasma protein plasminogen.  This system of enzymes dissolves blood clots by the lysis of fibrin.  Fibrinolysis plays a role as well in other biological processes such as tissue repair, macrophage activation and function, ovulation, and embryo implantation.  Fibrinolysis is mediated by plasmin and […]

Heparin: Factors Affecting & it’s Effects

HEPARIN ONSET: Maximal at 1 minute past atrial delivery: Measured at radial artery.  Note:  10-20% reduction in svr without affecting c.o. and or h.r. LUNG VS MUCOSAL: Mucosal requires larger doses- but can be reversed with 25-30% less protamine:  greater postoperative blood loss associated with mucosal heparin- speculated to result from lower molecular weight & […]

Hemostasis Assays

Tests Available Screening Tests:     Prothrombin Time (PT)     activated Partial Thromboplastin Time (aPTT)     Thrombin Clotting Time (TCT)     Kaolin Clotting Time (KCT) Assessment of the Fibrinolytic Pathway:     Alpha-2-antiplasmin – functional assay     Euglobulin Lysis Time     Fibrinogen/fibrin degradation products (FDP)     Plasmin alpha-2-antiplasmin complex (PAP)     Plasminogen Activator Inhibitor – antigen (PAI-1) […]

Coagulation Cascade

Intrinsic Pathway The coagulation cascade is initiated when blood becomes traumatized by exposure to a foreign surface.  An example of this is the initiation of cardiopulmonary bypass.  Blood contact with the polyvinyl chloride tubing utilized in the extracorporeal circuit, the squeezing mechanism of the roller head pump, and various applications of blood filtering devices, all […]

Blood Components

Separating Components from Whole Blood Fibrinogen Fibrinogen is a high molecular weight protein occurring in the plasma in quantities of 100 to 700 mg/dl.  In the presence of calcium ions it becomes the precursor for fibrin threads the foundation of the blood clot.  In terms of replacement therapy, a target value of 150 mg/dl may […]