Preventing, minimizing, and managing postoperative bleeding.
BACKGROUND
Most bleeding in cardiovascular surgery is biological, not surgical, the result of disseminated intravascular coagulation in its latter phases. Disseminated intravascular coagulation bleeding affects all levels of the coagulation systems, requiring stabilization of the platelet system, balancing the procoagulant system and its regulation, and stopping the fibrinolytic system's activation.


METHODS
The article discusses the multisystem protocol put into place at the Cardiovascular Surgery Department of La Pitié Hospital in Paris to diagnose and treat DIC bleeding so as to slow down causes of its occurrence and prevent further deterioration of the hemostatic systems.


RESULTS
All biological bleeding was controlled, permitting detection of other causes of bleeding and allowing rational use of blood products. No thromboembolic accident occurred. There was an absence of iatrogenic bleeding. The protocol also detects disseminated intravascular coagulation in patients who did not bleed to take early and frequently lifesaving measures.


CONCLUSIONS
This demonstrates the need to treat bleeding through a multisystem approach, monitoring its evolution by means of biological tests to be able to provide appropriate treatment.
Pavie
A
A
Department of Thoracic and Cardiovascular Surgery, La Pitié Hospital, Paris, France.
Szefner
J
J
Leger
P
P
Gandjbakhch
I
I
D001780:Blood Coagulation Tests; D004211:Disseminated Intravascular Coagulation / Q000209:etiology / Q000517:prevention & control*; D006353:Heart-Assist Devices; D006488:Hemostasis, Surgical; D006801:Humans; D010297:Paris; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors