Point-of-Care Testing—Real Time Monitoring The monitoring of the coagulation system assists with blood clot formation after cardiac surgery by allowing for early and pre-emptive intervention during the operative pro-

P52 Coagulation is a complex process that results in blood forming clots at tissue and vessel sites where damage has occurred, thereby stopping bleeding. Cardiac surgery extensively alters the normal coagulation process both intentionally and unintentionally. More often than not, cardiac surgery uses cardiopulmonary bypass (CPB) for intervention and surgical correction. Before initiating cardiopulmonary bypass the coagulation system is deactivated with anticoagulants, such as heparin, to prevent blood clotting from CPB associated surface activation and tissue damage. Once the surgical procedure has been completed the coagulation system must be reactivated so that normal hemostasis may proceed to stop surgical bleeding at the site of the assaulted tissues. Furthermore, confounders such as hemodilution, platelet consumption, CPB-induced inflammation, and a potential procoagulant response associated with heparin reversal may make clotting less likely to occur. To promote post cardiac surgery clotting—clotting when you want it—a multi-disciplinary approach is required. This includes optimizing the patient’s hematological profile before CPB, minimizing the deleterious effects of CPB on the blood by circuitry selection and anticoagulation strategy, and promoting post CPB clotting by reducing the dilution and consumption of red blood cells, platelets, and plasma proteins. It is also important to quickly identify why clotting is not occurring and correct any deficiencies in the coagulation system .