Excess perioperative bleeding remains a major complication following surgery, resulting in increased morbidity and mortality. The principal causes of non-surgical haemostatic perioperative bleeding are a pre-existing undetected bleeding disorder, related to the nature of the operation itself or from coagulation abnormalities arising from massive blood loss. Very often, it is a combination and coexistence of various pathologies. Identifying patients at risk remains a major component of preventing excessive blood loss. Understanding the haemostatic changes occurring in the perioperative period, especially in complex procedures like cardiopulmonary bypass and orthotopic liver transplantation is crucial in developing new strategies for the management of perioperative bleeding. Pharmacological interventions, especially aprotinin, tranexamic acid, desmopressin and increasingly, recombinant VIIa are being used both in prophylaxis and therapeutically to stop bleeding. The use of near patient testing like thromboelastography and platelet function analyser has allowed for more detailed assessment of the various steps of haemostasis. One of the main goals is to reduce the usage of allogeneic blood transfusion and its attendant risks.

中文翻译：

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围手术期出血的处理。

术后围手术期出血过多仍然是主要并发症，导致发病率和死亡率增加。非手术止血围手术期出血的主要原因是预先存在的未发现的出血性疾病，与手术本身的性质或大量失血引起的凝血异常有关。通常，它是各种病理的组合和共存。识别有风险的患者仍然是防止过多失血的主要组成部分。了解围手术期发生的止血变化，尤其是在诸如体外循环和原位肝移植等复杂手术中，对于开发围手术期出血的新治疗策略至关重要。药理干预措施，尤其是抑肽酶，氨甲环酸，去氨加压素以及越来越多的重组VIIa被用于预防和治疗以止血。血栓弹力描记术和血小板功能分析仪等近距离患者测试的使用，可以对止血的各个步骤进行更详细的评估。主要目标之一是减少同种异体输血的使用及其伴随的风险。