[Diagnostics and management of perioperative bleeding disorders]

Perioperative bleeding is and remains a major complication during and after surgical interventions, resulting in increased morbidity and mortality. The main causes of a non-primary vascular-related bleeding are congenital or multifactorial pre-existing hemostatic disorders that have not yet been diagnosed, the operating procedure itself and acquired hemostatic abnormalities as a secondary phenomenon, e.g., after excessive volume depletion in hypothermia, trauma or extracorporeal circulation, concomitant hypothermia and loss or consumption of coagulation factors and thrombocytes. Beginning with the preoperative preparation, including an extensive medical history, the detection of potential risk factors for increased bleeding including the precise description of current medication is required and prophylactic strategies and procedures should be initiated. In cases of excessive bleeding it is essential to implement adequate diagnostic and therapeutic algorithms, which are suitable for the partly complex and variable alterations of the hemostasis (e.g., in interventions after trauma or with extracorporeal circulation). A multimodal management is necessary to improve the patient's outcome, to limit the administration of blood products to that which is absolutely necessary and to minimize the risks associated with transfusion.