Of the pharmacologic hemoconservation strategies which decrease blood loss and allogeneic blood transfusion after cardiac surgery, aprotinin, epsilon aminocaproic acid, and tranexamic acid are effective prophylactic agents which have been the subject of recent interest. Their mechanism of action is explained by the interaction of the contact activation, fibrinolytic, and inflammatory systems with platelets that occurs during clinical cardiopulmonary bypass. Desmopressin acetate has limited demonstrated efficacy. Nafamostate mesilate and platelet glycoprotein IIb/IIIa receptor antagonists are potential hemoconservation agents under investigation. When excessive bleeding occurs after cardiopulmonary bypass, treatment selection on the basis of immediately available results of coagulation testing restores hemostatic function more effectively than empiric therapy chosen before conventional laboratory test results are known. Simple bedside coagulation monitors can provide this rapid diagnostic information. Thromboelastography may predict excessive bleeding but the diagnostic and therapeutic roles of this test are not yet defined.
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