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The Blood CME Center Develops New Program on Coagulopathy in Cardiac Surgery

Clotting, a response to traumatic or surgical injury, is a complicated process that comprises platelet-mediated primary hemostasis, explosive thrombin generation, conversion of fibrinogen to fibrin, and a stable fibrin and platelet network.



Challenges in Perioperative Hemostasis: Managing Coagulopathy in Elective and Urgent Cardiac Surgery, the latest CME program developed exclusively for the Blood CME Center, brings together two faculty members from Duke University Medical Center—Ian J. Welsby, MD, MBBS, FRCA, Assistant Professor of Anesthesiology and Critical Care, and Peter K. Smith, MD, Professor and Division Chief of Cardiovascular and Thoracic Surgery—to provide insight and perspective on frequently encountered complications of cardiac surgery due to bleeding.
In the first part of the program, Dr. Welsby discusses the preoperative management of elective cardiac patients, detailing several elements of the patient workup, including:
  • Patient’s medical history of bleeding
  • Medications, especially platelet inhibitors and anticoagulants
  • Lab values: platelet count, platelet function, PT/INR, aPTT, and fibrinogen levels



Dr. Welsby continues the discussion with his perspective on treating coagulopathy with blood products, managing refractory coagulopathy with factor concentrates, and restoring both primary hemostasis and thrombin generation.

The second part of the program features Dr. Smith’s discussion of the causes for perioperative bleeding in cardiac surgery, which he describes as multifactorial, and the complications that bleeding can produce.

Dr. Smith presents Harold C., a patient undergoing urgent aortic valve replacement for aortic stenosis and LIMA to LAD with CPB. His medical history includes a prior MI, heart failure, and hypertension.

As the case progresses, the patient becomes coagulopathic and the learner is asked to decide what next steps should be taken to restore hemostasis.

This patient’s case demonstrates the following:
  • CPB is often a cause of hemostatic imbalance
  • It is essential to normalize clotting factor levels and platelet function and to inhibit fibrinolysis to achieve hemostasis
  • Controlling perioperative bleeding necessitates the employment of a multifactorial approach
  • Massive uncontrollable coagulopathic bleeding occurs with currently approved therapies and may not respond to normal measures

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Postgraduate Institute for Medicine (PIM), the Cardiovascular & Metabolic Health Foundation, and Educational Concepts in Medicine. PIM is accredited by the ACCME to provide continuing medical education for physicians.

Postgraduate Institute for Medicine designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

To register and view the entire program, hear the faculty’s responses to key questions, and earn CME credit, Click here to enter program


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