Chapter 24: Management of Patients with Bleeding Diathesis

The following sections are included:

• Assessment of haemorrhage should include classification of haemorrhage severity and checking blood parameters including full blood count (FBC), coagulation parameters, fibrinogen level, renal function and liver function tests.

• Peri-operative management of haemorrhage includes activation of the major haemorrhage protocol, administration of oxygen and IV fluids and early surgical or endovascular intervention to stop the bleeding.

• Acidosis and hypothermia are confounding factors which can exacerbate bleeding and should be addressed.

• Targeted procoagulation interventions should be considered, which include administration of fibrinogen, cryoprecipitate, FFP and platelets.

• Antifibrinolytic agents and recombinant factor VIIa can have a role.

• Antidotes are now available for most of the antithrombotic drugs including the new oral anticoagulants (NOACs).

• Post-operatively, antithrombotic therapy or venous thromboembolism (VTE) prophylaxis should be recommenced once haemostasis has been achieved.