RT Book, Section A1 Choi, Hanwool Ryan A1 Lewis, Choy A2 Freeman, Brian S. A2 Berger, Jeffrey S. SR Print(0) ID 1135739967 T1 Cardiopulmonary Bypass: Anticoagulation T2 Anesthesiology Core Review: Part Two Advanced Exam YR 2016 FD 2016 PB McGraw-Hill Education PP New York, NY SN 9781259641770 LK accessanesthesiology.mhmedical.com/content.aspx?aid=1135739967 RD 2024/10/08 AB The utilization of cardiopulmonary bypass (CPB) offers a dichotomy in the need for complete anticoagulation in preparation for and while on CPB and for hemostasis at the end of CPB. The surgical process itself stimulates the release of thrombogenic substances such as tissue factor. Furthermore, blood has a natural tendency to clot when it encounters foreign surfaces and in addition, the presence of a foreign substance incites an inflammatory response that further increases the propensity of the blood to clot. Because of this, the blood circulating through the cardiopulmonary bypass circuit is at high risk for clotting if special anticoagulation strategies are not employed. Such strategies include but are not limited to anticoagulation of the patient’s blood and the bypass circuit priming solution prior to placement of cannulas in the patient, as well as the use of heparin bonded bypass circuits. Patients are generally kept anticoagulated for the duration of the bypass period. At the completion of the bypass period, the heparin effect is reversed, usually with protamine. This is done to achieve hemostasis in an effort to stave off or limit postoperative bleeding. In this chapter, we will review anticoagulation in preparation for and during CPB and strategies to achieve hemostasis after the bypass period.