Thrombosis and Cardiopulmonary Bypass

We face a profound and irreconcilable tension in the OR that is as old as the first use of heparin for cardiopulmonary bypass (CPB), 56 years ago. Our patients are treated with antiplatelet and anticoagulant drugs prior to surgery, with markedly improved short-term survival after MI and overall long-term survival. The “Wood” and “This Old House” magazines I receive every month contain 2 page ads for Plavix. Yet when I step into the OR in the morning, I am constantly reminded by my colleagues that the patient had Plavix yesterday and so I better order some platelets. By contrast, I am constantly reminded how we should not be transfusing patients, as blood products are bad. Within a few days after surgery the patient is back on Plavix for prevention of thrombosis of his coated stents. In essence, we crave perfect platelet and coagulation function for about 24 hours after completion of surgery, in the face of deliberate anticoagulation, platelet inhibition and depletion of all components of the coagulation system by surgery and CPB.