Critical bleeding in surgery: conventional therapy and new prospects.
Perioperative bleeding is one of the most frequent complications of surgery. Management of bleeding consists of local control (surgical or endoscopic hemostasis), measures to retain adequate circulation and proper transfusion procedures. In this review we will discuss various agents with a prohemostatic potential and their efficacy to reduce perioperative blood loss. Desmopressin increase the plasma concentration of Von Willebrand factor giving an augmentation of primary hemostasis. The use of recombinant activated factor VII is based on the evidence that activation of coagulation in vivo predominantly proceeds by the tissue factor/factor VII (a) pathway. Agents that exerts anti-fibrinolytic activity are aprotinin and the group of lysine analogues. The prohemostatic effect is due to inhibition of fibrinolysis and to a protective effect on platelets. Prohemostatic therapy may achieve an improvement of hemostasis, by amelioration of primary hemostasis, stimulation of fibrin formation or inhibition of fibrinolysis and seems to be effective in reducing perioperative blood loss and transfusion requirements.
Levi
M
M
Department of Vascular Medicine/Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. m.m.levi@amc.uva.nl
D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006801:Humans