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Table 2 Causes for peri- and postoperative bleeding complications and factors with influence on bleeding in abdominal surgery

From: Recombinant activated factor VIIa for the treatment of bleeding in major abdominal surgery including vascular and urological surgery: a review and meta-analysis of published data

Vascular lesion

Surgical

Intervention-related, accidental vascular lesion, suture insufficiency

 

Congenital

Hereditary connective tissue diseases such as Ehler-Danlos syndrome, hereditary hemorrhagic telangiectases, cavernous giant hemangioma

 

Acquired

Henoch-Schoenlein purpura, amyloidosis, gammopathies

Impairment of primary hemostasis (thrombocytic)

Congenital thrombocytopathy

Storage pool diseases (release disorders), Glanzmann thrombasthenia, Bernard-Soulier syndrome, Chediak-Higashi syndrome, Hermansky-Pudlak syndrome

 

Congenital thrombocytopenia

Fanconi anemia, Wiskott-Aldrich syndrome, Thrombocytopenia-Absent-Radius syndrome

 

Acquired thrombocytopathy

Treatment with platelet function inhibitors or nonsteroidal anti-inflammatory drugs, hypothermia, uremia, liver cirrhosis, extracorporal circulation, monoclonal gammopathies, malign thrombocytosis, volume replacement solutions, Dextran, high-molecular-weight HES solutions

 

Acquired thrombocytopenia

Coagulopathy due to consumption or blood loss, extracorporal circulation, immunological, sepsis, drug-induced (for example, heparin-induced thrombocytopenia type II, but bleeding is rare)

Impairment of secondary hemostasis (plasmatic)

Congenital deficiency or reduced activity

Hemophilia A or B, rare deficiencies of other factors (fibrinogen, factors II, V, VII, X, and XI), factor XIII deficiency

 

Acquired deficiency

Deficiency of vitamin-K-dependent factors during oral anticoagulation or liver disease, acquired hemophilia with inhibitors, coagulopathy due to consumption or blood loss

 

Acquired reduction of activity

Hypothermia, acidosis, drug-induced: administration of unfractionated or low-molecular-weight heparin, of factor Xa inhibitors, of thrombin inhibitors, or of asparaginase. Diseases with impairment of fibrin polymerization (for example, acquired factor XIII deficiency) or volume replacement solutions (HES, gelatine)

Combined impairments of hemostasis (thrombocytic-plasmatic)

Congenital deficiency or reduced activity

von Willebrand disease

 

Acquired deficiency

Organ-associated (for example, liver disease), acquired von Willebrand syndrome (for example, myelodysplastic syndrome), drug-induced (valproic acid), carriers of mechanic heart valves (aortic valve), aortic stenosis (high degree), high-molecular-weight HES solution

Impairment of fibrinolysis (hyperfibrinolysis)

Acquired

Hypothermia, acidosis, release of activators of fibrinolysis (for example, operations or damage of malignant tumors, uterus, prostate)

  1. HES, hydroxyethyl starch.