Antithrombotic and anticoagulation management
Antithrombotic and anticoagulation therapy was managed according to
European Association for Cardio-Thoracic Surgery (EACTS) Guidelines on
perioperative use of drugs in adult cardiac surgery(14). Before CPB, 300UI/kg unfractionated heparin
(UFH) was administered to achieve an activated clotting time (ACT)
greater than 480 seconds. At the end of CPB, UFH neutralization was
achieved using protamine sulfate 1 mg/100 UI of heparin. Postoperative
anticoagulant strategy was managed with the application of a
standardized protocol of administration of vitamin K antagonists (VKA)
starting from the first postoperative day to reach an INR equal to 2.5
for mechanical prostheses and 2.0 for biological prostheses and
valvuloplasty. Low molecular weight heparin (LMWH) bridging
anticoagulation was used in the first 12-24 hours until the INR ratio
goal was achieved.