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Risk factors for bleeding in major abdominal surgery using heparin thromboprophylaxis
A T Cohen1, M B Wagner, M S Mohamed
1Department of Medicine, King's College School of Medicine and Dentistry, London, United Kingdom.
Background:
Patients undergoing major abdominal surgery are at risk of both bleeding and thrombotic complications and usually receive heparin thromboprophylaxis.
Patients And Methods:
Risk factors for perioperative bleeding were examined in 3,809 patients in a double-blind, randomized trial investigating heparin thromboprophylaxis. The risk factors were modeled by logistic regression, and a risk score was calculated using the significant factors in the model.
Results:
Bleeding was associated with the following factors in the model, given as adjusted odds ratios (ORa [95% confidence interval]): male sex (ORa 1.68 [1.21 to 2.34] P = 0.003), malignancy (ORa 1.69 [1.21 to 2.34] P = 0.008), gynecological surgery (ORa 1.62 [1.12 to 2.35] P = 0.011), and complex surgery (ORa 2.7 [2.02 to 3.62] P < 0.001). The risk of excessive bleeding for 0, 1, 2, and 3 risk factors was 2%, 6%, 11%, and 21%, respectively.
Conclusions:
The recognition of patients with these risk factors associated with perioperative bleeding should result in increased vigilance and may lead to modification of surgical and medical therapy.