Risk of postoperative hemorrhage

The problems of postoperative hemorrhage may be due to the result of an injury or trauma. They can also be by the way blood is clotted. The different types of blood vessels carry oxygen and nutrients to the tissues. When blood vessels or capillaries suffer some damage, bleeding may occur inside or outside.

Hemostasis is the interruption of bleeding from damaged blood vessels. The factors necessary for a clot to form include:

• Platelets: Platelets are very small cells produced by the bone marrow. The normal number of platelets is 150,000 to 400,000.
• Blood coagulation factors: These factors are found in the blood and are mainly produced in the liver.

Surgical intervention is associated with an increased risk of thromboembolism venous and arterial. It is also known that the temporary interruption of the antithrombotic treatment supposes a greater exposure to risk of thrombosis and embolism.

The risk of preoperative bleeding induced by oral anticoagulants is usually low. But nevertheless, It is high during and after surgery, depending on the surgical procedure.

Risk factors for postoperative hemorrhage

The assessment of risk in relation to the surgical procedure is necessary in this type of patients. For this reason, The type of action with respect to antithrombotic treatment is determined by the patient's situation.

Both thrombotic and hemorrhagic risk should be assessed of the surgical procedure. The thrombotic risk of the surgical procedure is important because of the relationship with the increased risk of thrombosis when the anticoagulant / antiaggregant treatment is interrupted.

In these cases, it is possible to opt for the continuity of the anticoagulant treatment or to interrupt it. Indicating replacement by heparin and, subsequently, restart the therapy with oral anticoagulant drugs. This is due, above all, to postoperative immobility, but also to the prothrombotic effect of surgery itself.

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Post-surgical hemorrhage

The Major hemorrhage that requires a transfusion of more than two units, reoperation or bleeding in the intracranial, intrathoracic or peritoneal cavity.

The attitude to any hemorrhagic complication will depend on the importance and location of the bleeding. It also depends on the level of anticoagulation. It also defines the Major hemorrhages such as fatal or life threatening hemorrhages.

The probability of bleeding will also condition the restart of treatment postoperative antithrombotic, since the start of anticoagulation will be deferred in cases of high risk of hemorrhage. If anticoagulation is suppressed for more than one day, the possibility of administering heparin should be considered.

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Resumption of anticoagulant treatment after surgery

The resumption of anticoagulant treatment after surgery should not be started until 2-3 days after surgery. However, it should always be done after consulting with the specialist.

It should begin with low doses, ie, those used in prophylaxis, 2-3 days after surgery. The use of therapeutic doses starts after 48-72 hours, and they should not be used after continuous postoperative bleeding.

In the majority of patients treated, with both warfarin and acenocoumarol, it can be resumed the night of the day of the intervention. This may be so as long as there are no bleeding complications.

However, the therapeutic effect will not begin until 4-5 days after beginning the anticoagulant treatment. One of the main objectives for the anticoagulated patient is recover its antithrombotic state as soon as possible. It is necessary to take into account an adequate postoperative haemostasis and the risk of bleeding associated with the surgical procedure.

In general, most of the Postoperative hemorrhages resolve within 24 hours after surgery. However, it may be the case that this is not the case, so the start of anticoagulation should not be started until hemostasis returns to normal.