Submitted by Afshan Idrees

Bleeding during cardiac surgery

A 61-year-old man with an unruptured ascending aortic aneurysm and severe mitral regurgitation underwent ascending aortic replacement and mitral valve repair. During surgery, increased bleeding was noticed. Intraoperative ROTEM was performed. Which assay would you like to see to evaluate the intrinsic cascade? Which assay would you analyze next to rule out heparin effect on prolonged CT?