Perioperative Considerations in Management of the Severely Bleeding Coagulopathic Patient

( Anesthesiology. 2023; 138:535–560) This clinical review explored coagulopathy in severely bleeding patients after major surgery (eg, cardiac surgery with cardiopulmonary bypass or CPB), serious trauma, and postpartum hemorrhage. There are a multitude of surgical and nonsurgical factors, or a mix of both, that can cause perioperative bleeding in patients. This includes fibrinolysis, metabolic acidosis, platelet impairment, thrombocytopenia, coagulation factor deficiency, activation of inflammatory pathways, hemodilution, hypothermia, and hypovolemia. Bleeding patients can often have previous hemostatic issues because of oral anticoagulants or antiplatelet therapy.