Perioperative management of the bleeding patient.


Journal Article (Review)

Perioperative bleeding remains a major complication during and after surgery, resulting in increased morbidity and mortality. The principal causes of non-vascular sources of haemostatic perioperative bleeding are a preexisting undetected bleeding disorder, the nature of the operation itself, or acquired coagulation abnormalities secondary to haemorrhage, haemodilution, or haemostatic factor consumption. In the bleeding patient, standard therapeutic approaches include allogeneic blood product administration, concomitant pharmacologic agents, and increasing application of purified and recombinant haemostatic factors. Multiple haemostatic changes occur perioperatively after trauma and complex surgical procedures including cardiac surgery and liver transplantation. Novel strategies for both prophylaxis and therapy of perioperative bleeding include tranexamic acid, desmopressin, fibrinogen and prothrombin complex concentrates. Point-of-care patient testing using thromboelastography, rotational thromboelastometry, and platelet function assays has allowed for more detailed assessment of specific targeted therapy for haemostasis. Strategic multimodal management is needed to improve management, reduce allogeneic blood product administration, and minimize associated risks related to transfusion.

Full Text

Duke Authors

Cited Authors

  • Ghadimi, K; Levy, JH; Welsby, IJ

Published Date

  • December 2016

Published In

Volume / Issue

  • 117 / suppl 3

Start / End Page

  • iii18 - iii30

PubMed ID

  • 27940453

Pubmed Central ID

  • 27940453

Electronic International Standard Serial Number (EISSN)

  • 1471-6771

Digital Object Identifier (DOI)

  • 10.1093/bja/aew358


  • eng

Conference Location

  • England