Understanding the delicate balance between bleeding and thrombosis: can we use it to our advantage?

Hemostasis remains an issue in cardiac surgery because many patients are preoperatively on platelet-inhibiting drugs, whereas other patients such as those with an evolving acute myocardial infarction present themselves in a more prothrombotic status. Classical laboratory tests such as activated partial thrombin time and plasma thromboplastin are poor in predicting blood loss and bleeding problems postcardiac surgery. This is explained by the fact that these tests are performed on plasma instead of on whole blood. Whole blood coagulation tests are superior in detecting coagulation deficits and bleeding because they take the cellular interaction in the coagulation cascade into account.