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Altered Fibrinolysis during and after Surgery
Maria J Colomina1,2, Esther Méndez1, Antoni Sabate1,2
1Department of Anaesthesia and Critical Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain.
Seminars in Thrombosis and Hemostasis
|April 20, 2021
Summary
Major surgery causes significant hemostatic changes, leading to a hypercoagulable state. Understanding these shifts is crucial for managing bleeding risks and optimizing patient outcomes during and after surgery.
Area of Science:
- Anesthesiology
- Hematology
- Surgical Sciences
Background:
- Major surgery triggers complex hemostatic alterations, including fluid shifts, coagulation protein dilution, and increased fibrinogen and platelets.
- These changes can lead to a postoperative hypercoagulable state, though hemorrhagic tendencies may arise in specific scenarios like prolonged cardiopulmonary bypass or comorbidities.
- Acquired coagulopathy can also develop due to blood loss, factor consumption, hemodilution, and preoperative use of anticoagulant/antiplatelet medications.
Purpose of the Study:
- To review the multifaceted hemostatic and coagulation changes occurring during major surgery.
- To explore conditions that can disrupt normal hemostasis, leading to either hyperfibrinolysis or hypofibrinolysis.
- To evaluate the utility of tranexamic acid and point-of-care testing in managing surgical hemostasis.
Main Methods:
- Literature review focusing on surgical hemostasis and coagulation.
- Analysis of factors influencing hypercoagulable and hemorrhagic states during surgery.
- Evaluation of therapeutic interventions and diagnostic tools.
Main Results:
- Surgery-induced stress, tissue injury, and inflammation initiate a cascade of hemostatic changes.
- A postoperative hypercoagulable state is common, characterized by increased fibrinogen and platelets, but can be complicated by bleeding in certain surgical contexts.
- Specific situations like extracorporeal circulation and severe hemodynamic disturbances can induce hyperfibrinolysis, while overcorrection or factor consumption can also impact coagulation balance.
Conclusions:
- Understanding the dynamic changes in hemostasis during surgery is essential for effective patient management.
- Tranexamic acid shows promise for prophylaxis and treatment of bleeding, and point-of-care testing aids in real-time assessment of fibrinolysis.
- Tailored management strategies are necessary to address the spectrum of hemostatic challenges encountered in surgical patients.
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