A patient with a mechanically assisted circulation may develop a hemostatic disorder. Some are related to the shear-related effects on the blood.
Mechanically assisted circulations include:
(1) extracorporeal membrane oxygenation (ECMO)
(2) ventricular assist device (VAD)
(3) cardiopulmonary bypass (CPB)
Types of hemostatic disorder:
(1) anticoagulant-related
(2) thrombocytopenia
(3) fibrin consumption
(4) acquired von Willebrand syndrome
(5) DIC (encompasses thrombocytopenia and fibrin consumption)
Sites of bleeding include:
(1) cannula sites
(2) gastrointestinal
(3) surgical site
(4) pulmonary
(5) intracerebral
(6) cutaneous
In addition to bleeding, the patient may be at increased risk of thrombosis due to platelet activation and other shear-related effects and patient factors (decreased mobility, surgery, etc).
