[Coagulation management of severe surgical bleeding]

Area of Science:

• Anesthesiology and Perioperative Medicine
• Hematology
• Critical Care Medicine

Context:

• Severe intraoperative bleeding poses significant risks, including mortality, increased resource utilization, and elevated perioperative costs.
• The complex causes of perioperative coagulopathy involve depletion, consumption, and dilution of clotting factors and platelets, exacerbated by factors like hypothermia, acidosis, and anemia.

Purpose:

• To emphasize the critical need for early and precise diagnosis of perioperative coagulopathy.
• To highlight the importance of utilizing clinical bleeding assessment and point-of-care coagulation testing, such as thrombelastography, for guiding therapeutic strategies.

Summary:

• Hypofibrinogenemia is often the initial trigger in previously healthy patients, with thrombocytopenia typically occurring later in massive bleeding scenarios.
• Available therapies include fresh frozen plasma, clotting factor concentrates, platelet concentrates, and antifibrinolytic drugs.
• Optimal patient benefit is achieved by administering these therapeutic products according to a structured algorithm.

Impact:

• Facilitates timely and targeted interventions to mitigate life-threatening bleeding.
• Improves patient safety and reduces the economic burden associated with surgical complications.
• Promotes evidence-based management of coagulopathy, leading to better clinical outcomes.