CCS Hemostasis and Coagulation Management

Question 1

What is the target activated clotting time (ACT) required before initiating cardiopulmonary bypass (CPB)?

Accepted Answer

Greater than 480 seconds

Answer

An ACT greater than 480 seconds is required before CPB to ensure adequate anticoagulation and prevent clot formation in the circuit.

Question 2

Which anticoagulant is the standard of care for anticoagulation during cardiopulmonary bypass?

Accepted Answer

Heparin

Answer

Unfractionated heparin is the standard anticoagulant for CPB because its effect can be rapidly reversed with protamine sulfate and is easily monitored via ACT.

Question 3

What is the standard initial heparin dose given before cardiopulmonary bypass in cardiac surgery?

Accepted Answer

300 units/kg

Answer

300 units/kg of unfractionated heparin is the standard initial dose to achieve adequate anticoagulation for CPB.

Question 4

Which drug is used to reverse heparin anticoagulation at the conclusion of cardiopulmonary bypass?

Accepted Answer

Protamine sulfate

Answer

Protamine sulfate neutralizes heparin by forming a stable complex, effectively reversing anticoagulation at the end of CPB.

Question 5

A patient on chronic warfarin therapy requires emergent cardiac surgery. What is the most appropriate immediate intervention to reverse anticoagulation?

Accepted Answer

Give 4-factor prothrombin complex concentrate (4F-PCC)

Answer

4-factor PCC provides rapid reversal of warfarin by replacing clotting factors II, VII, IX, and X, which is critical in emergency settings when there is no time for vitamin K to take effect.

CCS - Certified Cardiac Surgeon Practice Test

CCS - Certified Cardiac Surgeon Practice Test

CCS Hemostasis and Coagulation Management