Perioperative Coagulation Management – Treatment Strategies in Cardiovascular Surgery Patients

Perioperative coagulation management is central to cardiovascular surgery patients, shaping outcomes in this highly vulnerable patient cohort. Clinicians must continuously balance bleeding and thrombosis risks while (patho-)physiology shifts rapidly due to inflammation, shock, hypothermia, organ dysfunction, and exposure to anticoagulants and blood products. This balancing act is particularly challenging during extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass (CPB), and becomes even more complex when heparin-induced thrombocytopenia (HIT) is suspected or confirmed. This Research Topic will provide a clinically focused forum for state-of-the-art, practice-oriented advances that strengthen decision-making, monitoring, and implementation of both prohemostasic and anticoagulation strategies across the patient pathway from the operating room to the ICU. We welcome contributions that translate coagulation diagnostics into action: how teams move from thrombocytopenia, bleeding, or thrombosis to risk stratification, differential diagnosis (including HIT), anticoagulant selection and reversal planning, monitoring targets, transfusion, and safe procedural management. Particular attention is encouraged for high-risk scenarios such as HIT in patients requiring ECMO, anticoagulation strategies for CPB in current or prior HIT, and broader coagulation challenges in critical illness, including hypercoagulability and coagulopathy in shock, inflammation, or organ failure.We particularly welcome Original Research, Methods, and Brief Research Reports evaluating structured protocols, monitoring strategies, and scalable systems to standardize care across operating room–ICU transitions, but all accepted article types will be considered. Please note that Case Reports are not an accepted article type for this collection.Submissions may include, but are not limited to:• HIT in cardiovascular perioperative and ICU populations: diagnostic strategies and real-world testing pathways (including pre-test probability tools and functional assays), and therapeutic management, including anticoagulation transitions and peri-procedural planning.• ECMO anticoagulation and hemostasis: anticoagulant selection (including alternative approaches), dosing and monitoring, and management of circuit thrombosis or oxygenator dysfunction.• Monitoring and targets in complex physiology: comparative performance and implementation of ACT, aPTT, anti-Xa, viscoelastic testing, platelet function testing, and multimodal monitoring—especially in inflammation, hypothermia, liver dysfunction, renal failure, and high-transfusion states.• Perioperative transfusion, reversal, and goal-directed hemostasic management: factor concentrates, antifibrinolytics, platelet transfusion strategies, procedure-oriented hemostasis planning, and transfusion algorithms linked to outcomes such as bleeding, re-exploration, thrombosis, and ICU length of stay.By focusing on practical perioperative coagulation strategies and the evidence behind them, this Research Topic aims to share reproducible approaches that support interdisciplinary teamwork, reduce unwarranted variation, and improve anticoagulation and prohemostasic decisions in cardiovascular surgery – especially for the highest-risk scenarios involving HIT, ECMO, and CPB. Topic editors: Johannes Gratz, Marion Wiegele Source: https://www.frontiersin.org/research-topics/78742/perioperative-coagulation-management---treatment-strategies-in-cardiovascular-surgery-patients