Perioperative Bleeding Management in Cardiovascular Surgery



 According to  Guidelines from the European Society of Anaesthesiology


Cardiovascular surgery:

Withdrawal of aspirin therapy increases the risk of thrombosis; continuation of aspirin therapy increases the risk of bleeding. A
Withdrawal of clopidogrel therapy increases the risk of thrombosis; continuation of clopidogrel therapy increases the risk of bleeding. A
We recommend that a prophylactic dose of low molecular weight heparin should be administered subcutaneously 8–12 h before elective CABG surgery. This intervention does not increase the risk of perioperative bleeding. 1B
We recommend that tranexamic acid or EACA should be considered before CABG surgery. 1A
We suggest considering prophylactic preoperative infusion of 2 g fibrinogen concentrate in patients with fibrinogen concentration < 3.8 g/L, because it may reduce bleeding following elective CABG surgery. 2C
Prothrombin complex concentrate is effective for rapid reversal of oral anticoagulation before cardiac surgery. A

We recommend that intraoperative tranexamic acid or EACA administration should be considered to reduce perioperative bleeding in high-, medium- and low-risk cardiovascular surgery. 1A
We recommend that tranexamic acid should be applied topically to the chest cavity to reduce postoperative blood loss following CABG surgery. 1C
We recommend that fibrinogen concentrate infusion guided by point-of-care viscoelastic coagulation monitoring should be used to reduce perioperative blood loss in complex cardiovascular surgery. 1B
We suggest that recombinant FVIIa may be considered for patients with intractable bleeding during cardiovascular surgery once conventional haemostatic options have been exhausted. 2B
We suggest that antiplatelet therapy with aspirin or clopidogrel may be administered in the early postoperative period without increasing the risk of postoperative bleeding. 2C
We suggest that rFVIIa may be considered for patients with intractable bleeding after cardiovascular surgery once conventional haemostatic options have been exhausted. 2B
We recommend the use of standardised haemostatic algorithms with predefined intervention triggers. 1A

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