title: Preoperative identification of patients with increased risk for perioperative bleeding.
abstract: OBJECTIVE
  Although the overall complication rate in cardiac surgery has been decreased, perioperative bleeding increasing morbidity and mortality is still frequent. Furthermore, the widespread use of new antithrombotic and antiplatelet agents presents an additional challenge in daily practice. Therefore, identifying patients with increased bleeding risk would be advantageous to optimize perioperative management.
  
  
  RESULTS
  Bleeding classifications are frequently discussed, but are of little relevance for the perioperative setting. In the nonsurgical setting the most relevant risk factors in bleeding prediction are age, renal disease, sex, pre-existing anemia, and the administration of antithrombotic/antiplatelet drugs. In cardiac surgery, the Papworth Bleeding Risk Stratification Score identifies mainly procedure-linked risk factors and might be one of the most suitable scores to be used. Routine laboratory screening appears to have limited utility.
  
  
  CONCLUSIONS
  Apart from precise bleeding history only insufficient data exist in cardiac surgery to exactly predict bleeding complications. Therefore, there is urgent need for further studies to improve perioperative bleeding management.
authors.affiliation: Department of Anesthesiology and Intensive Care, General Hospital Linz, Linz, Austria. hans.gombotz@akh.linz.at
authors.forename: Hans
authors.initials: H
authors.lastname: Gombotz
authors.forename: Hans
authors.initials: H
authors.lastname: Knotzer
mesh_terms: D000367:Age Factors; D000740:Anemia / Q000150:complications; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D010975:Platelet Aggregation Inhibitors