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.