Vücut dışı dolaşımda koagülasyon ve hemostaz

Açık kalp cerrahisi uygulanan hastalarda vücut dışı dolaşımın (VDD) kullanılması hemostatik sistemi olumsuz yönde etkilemektedir. Heparinize kanın VDD devrelerinde nonendotelyal biyomateryal yüzeylerle etkileşimi trombin oluşumuna yol açmaktadır. Ayrıca uygulanan hipotermi, ilaçlar ve hemodilüsyon koagülasyon sistemini aktive etmekte ve trombosit fonksiyonlarını bozmaktadır. VDD sırasında antikoagülasyon için kullanılan heparinin ve bunu nötralize etmek için uygulanan protaminin de pek çok yan etkisi vardır. Bu ilaçların kontrendike olduğu durumlar için alternatif ilaçlar geliştirilmiştir. Bu derlemede koagülasyonun fizyolojisi ve VDD'in hemostaz üzerine etkileri irdelenmiş, alınması gereken tedbir ve uygulamalar gözden geçirilmiştir.

Anahtar Kelimeler:

Kalp cerrahi işlemleri, Hemostaz, Heparin, Vücut dışı dolaşım, Kan pıhtılaşması, Toraks cerrahisi

Extracorporeal coagulation and hemostasis

Application of extracorporeal circulation SfiCC) in patients undergoing öpen heart surgery affects the hemostatic system detrimentally. The interaction of heparinised blood in the ECC with nonendothelial biomaterial leads to thrombin formation. Furthermore, induced hypothermia, drugs, and hemodilution activate the coagulation system and cause platelet dysfunction. Both Heparin, usedfor anti-coagulation during ECC, and Protamine, which is usedfor reversal, have many side effects. Alter-native agents have been developed in cases where these drugs are contra-indicated. in this review, the physiology of coagulation and the effects of ECC on hemostasis are presented and precautions and clinicalpractice are overviewed.

Keywords:

Cardiac Surgical Procedures, Hemostasis, Heparin, Extracorporeal Circulation, Blood Coagulation, Thoracic Surgery,

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