Pathophysiology of Bleeding in Surgery

M. Marietta, L. Facchini, P. Pedrazzi, S. Busani, G. Torelli

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Bleeding is a major surgical complication. Although mortality rates of 0.1% are observed for surgical procedures, it may be 5% to 8% for elective vascular surgery, and increase to 20% in the presence of severe bleeding. In major surgery for liver diseases, as well as in cardiac surgery, excessive blood loss is associated with increased mortality, morbidity, and intensive care stay. Approximately 75% to 90% of intraoperative and early postoperative bleeding is due to technical factors. However, in some cases either acquired or congenital coagulopathies may favor, if not directly cause, surgical hemorrhage. Uncontrolled bleeding leads to a combination of hemodilution, hypothermia, consumption of clotting factors, and acidosis, which in turn worsen the clotting process, further exacerbating the problem in a vicious bloody circle. At present, the standard treatment for surgical bleeding is the rapid control of the source of bleeding by either surgical or radiological techniques. Blood-derived products as well as hemostatic agents, such as aprotinin, tranexamic acid, and DDAVP, are widely used to improve hemostatic balance in bleeding patients. Recombinant activated factor VII (rFVIIa) has been reported to be effective for the treatment of surgical or traumatic massive bleeding unresponsive to conventional therapy. Although most reports are anecdotal, and therefore exposed to a "positive" selection bias, the number of cases is impressive, strongly suggesting that in such patients rFVIIa may afford a hemostatic advantage beyond that of conventional replacement therapy.

Original languageEnglish
Pages (from-to)812-814
Number of pages3
JournalTransplantation Proceedings
Volume38
Issue number3
DOIs
Publication statusPublished - Apr 2006

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Hemorrhage
Hemostatics
Surgical Blood Loss
Tranexamic Acid
Deamino Arginine Vasopressin
Factor VIIa
Hemodilution
Aprotinin
Blood Coagulation Factors
Mortality
Selection Bias
Therapeutics
Critical Care
Acidosis
Hypothermia
Thoracic Surgery
Blood Vessels
Liver Diseases
Morbidity
recombinant FVIIa

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Pathophysiology of Bleeding in Surgery. / Marietta, M.; Facchini, L.; Pedrazzi, P.; Busani, S.; Torelli, G.

In: Transplantation Proceedings, Vol. 38, No. 3, 04.2006, p. 812-814.

Research output: Contribution to journalArticle

Marietta, M, Facchini, L, Pedrazzi, P, Busani, S & Torelli, G 2006, 'Pathophysiology of Bleeding in Surgery', Transplantation Proceedings, vol. 38, no. 3, pp. 812-814. https://doi.org/10.1016/j.transproceed.2006.01.047
Marietta, M. ; Facchini, L. ; Pedrazzi, P. ; Busani, S. ; Torelli, G. / Pathophysiology of Bleeding in Surgery. In: Transplantation Proceedings. 2006 ; Vol. 38, No. 3. pp. 812-814.
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