Postoperative bleeding and coagulation disorders

New data have been made available in the field of haemostasis and thrombosis. Some long-awaited answers to important questions have been published, and some debates have benefited from an updated perspective.

Two important domains are addressed in this update: massive bleeding (1/1/1 ratios and fibrinogen concentrates) and the management of direct oral anticoagulants (monitoring and antidotes). Both are highly controversial topics. Higher plasma/platelets/red blood cells units ratios are now partly supported by a new study in trauma. Several studies show that preemptive doses of fibrinogen do not appear to bring any benefit. Monitoring of direct oral anticoagulants is now possible, and it has to be recommended in some circumstances. Specific antidotes are being developed, but there are still more questions than answers.

These new data should help anaesthesiologists and intensivists to better understand and manage massively bleeding patients or direct oral anticoagulants treated patients.