CVP Coagulation and Anticoagulation Management 3

Question 1

Post-CPB coagulopathy is most commonly caused by:

Accepted Answer

Dilutional coagulopathy combined with platelet dysfunction

Answer

Vitamin K deficiency from prolonged bypass

Answer

Warfarin effect from preoperative medications

Answer

Disseminated intravascular coagulation (DIC)

Question 2

Desmopressin (DDAVP) is indicated in cardiac surgery primarily to treat bleeding associated with:

Accepted Answer

Acquired platelet dysfunction including uremic and aspirin-related defects

Answer

Heparin rebound after protamine reversal

Answer

Hypofibrinogenemia post-bypass

Answer

Antithrombin III deficiency

Question 3

"Heparin rebound" occurring hours after successful protamine reversal is caused by:

Accepted Answer

Release of tissue-sequestered heparin after protamine is metabolized

Answer

Inadequate protamine dosing leaving residual circulating heparin

Answer

Synthesis of new heparin by mast cells stimulated by surgery

Answer

Auto-activation of factor Xa regenerating anticoagulant activity

Question 4

Cell salvage (autotransfusion) during cardiac surgery is contraindicated in which of the following situations?

Accepted Answer

Active bacterial endocarditis with bacteremic surgical field

Answer

Chronic renal failure with uremic platelet dysfunction

Answer

Sickle cell trait in a non-crisis patient

Answer

Patient age greater than 75 years

Question 5

The most common cause of platelet dysfunction during cardiopulmonary bypass is:

Accepted Answer

Contact activation of platelets by the CPB circuit surfaces

Answer

Hypocalcemia from citrated blood products

Answer

Heparin-mediated direct platelet inhibition

Answer

Hypothermia as the sole contributing factor

Question 6

Modified ultrafiltration (MUF) performed immediately after CPB provides which primary benefit?

Accepted Answer

Hemoconcentration and removal of inflammatory mediators

Answer

Reversal of residual heparin anticoagulation

Answer

Restoration of platelet count to pre-bypass levels

Answer

Correction of electrolyte imbalances only

Question 7

When a post-CPB TEG shows a widened angle (alpha angle) with reduced clot formation rate, the most appropriate intervention is:

Accepted Answer

Cryoprecipitate or fibrinogen concentrate

Answer

Platelet transfusion

Answer

Protamine supplementation

Answer

Fresh Frozen Plasma (FFP)