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A Cohen

and D Farran

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date: 02 August 2021

Heparin and protamine 92

Preoperative antithrombotic drugs 94

Bleeding and transfusion 96

The postoperative bleeding patient 102

Management of patients requiring postoperative anticoagulation 106

Further reading 107

To understand the use of pharmacological interventions, a broad overview of coagulation pathways is required.

Classically coagulation is described as extrinsic and intrinsic systems with a final common pathway. The extrinsic system involves exposed tissue factor which activates factor VII, and the intrinsic system is initiated by exposure of blood to collagen leading to activation of factors XII, XI, and IX. Both pathways generate active factor X, which in turn leads to thrombin and fibrin formation. In fact there is a more complicated and finely balanced system with cross-over of the two pathways....

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