Management of bleeding in vascular surgery

Area of Science:

• Anesthesiology
• Vascular Surgery
• Hematology

Background:

• Acute coagulopathy and blood loss present significant hemostatic challenges in major vascular procedures.
• Multifactorial origins of coagulopathy include tissue injury, hypotension, dilution, hypothermia, acidemia, and systemic inflammatory response.
• Antithrombotic use and intraoperative heparin complicate bleeding management.

Purpose of the Study:

• To review current strategies for managing acute coagulopathy and blood loss in major vascular surgery.
• To provide a structured, evidence-based approach to hemostasis in this patient population.

Main Methods:

• Review of existing literature and guidelines, with emphasis on adapting trauma management principles.
• Discussion of fluid resuscitation strategies, transfusion triggers, and component therapy.
• Consideration of antifibrinolytic agents and hemostatic agents.

Main Results:

• Permissive hypotension and restrictive fluid strategies are generally recommended.
• Red blood cell transfusion triggers should be restrictive but individualized for high-risk patients.
• Blood component transfusion guided by clinical bleeding and coagulation testing is crucial.

Conclusions:

• A scientific, rational, and structured approach to vascular hemostasis is essential.
• Prophylactic antifibrinolytics are recommended; fibrinogen and prothrombin complex concentrates for massive transfusion.
• Recombinant factor VIIa is reserved as a last resort; therapy should be monitored and goal-directed.