Pioneering approaches to managing bleeding

Walter Danker & Gerard Llanos discuss the burden of surgical bleeding, the importance of haemostatic agents and how management of surgical bleeding can be improved.

Millions of surgeries are conducted worldwide every year,1 and controlling a patient's bleeding during and after a procedure is a major focus for the care team. Excessive bleeding is common in adult in-patients, and various factors, including the general risk of surgery, can complicate these attempts. Structural issues, the effects of medication, disease or unexpected bleeding from an undiagnosed or newly acquired bleeding disorder, can all result in unplanned or excessive bleeding.2

Outside of surgery, haemorrhages are globally responsible for the majority of deaths of trauma patients who did not reach the hospital, and up to 40% of deaths for those who did.3 Other types of non-trauma haemorrhage — for example postpartum haemorrhage — are still a concern within the hospital setting.3

When encountering bleeding in patients, clinicians usually check whether the patient has a history of abnormal bleeding. Those with abnormal bleeding may have inherited bleeding disorders, such as platelet function disorders, von Willebrand disease, haemophilia, or rare factor deficiencies. Even patients with no history of excessive bleeding and no acquired blood clotting disorders may need to be checked for liver dysfunction, disseminated intravascular coagulation, or certain vitamin deficiencies.

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