Perioperative Coagulopathy and the Clinical Implications.

ABSTRACT

Perioperative bleeding as conceived in this review refers to the clinical scenario whereby there is impairment of blood coagulation leading to prolonged or excessive bleeding, accompanying trauma or surgical exposure. Aetiology of bleeding disorders could be classified under the following subheadings vascular disorders, Thrombocytopenia, Platelet function defects, Coagulation factors disorder(s). Primary haemostasis is initiated or triggered by the release of tissue factor at the site of injury leading to generation of small quantity thrombin, sufficient to activate platelets leading to the formation of prothrombin complex. The ability of FXa to activate FVII creates a link between the extrinsic and intrinsic coagulation pathways; leading to the generation of sufficient thrombin to convert fibrinogen to fibrin which organizes platelet plug to indissoluble clots (Secondary haemostasis) or thrombus formation. A balance is required between haemostasis, thrombosis and fibrinolysis to prevent perioperative coagulopathy. Whenever positive findings in the history and physical examination suggests an increased risk of significant bleeding, then it is more cost effective to carry out routine screening tests of coagulation. Specific coagulation tests used routinely has longer turnaround times and is not appropriate in the perioperative setting. Current recommendations for the prevention of massive bleeding in the perioperative setting; requires communication of appropriate treatment plans in a multidisciplinary setting, intraoperative monitoring, the treatment of underlying disorder, and replacement therapy with blood products. As point-of-care diagnostics becomes available in emergency areas, timely targeted intervention for haemorrhage control will result in better patient outcomes and reduced demand for blood products.