Perioperative Thrombosis and Hemostasis
04 February 2020 (online)
The life of an expert in thrombosis and hemostasis is never dull: indeed, some of the most challenging episodes in both of our professional lives have involved managing perioperative hemostatic problems. Both of us have offices close to our respective operative theaters and intensive care units, so a quick jog round after a telephone call asking for assistance with a major bleeding problem is often an illuminating way of helping. Certainly, when dealing with multiple trauma cases that require urgent surgery and/or bleeding critically ill patients, the place of the thrombosis and hemostasis expert is flitting among sites or managing other communication efforts to help ensure best practice in managing bleeding. This includes encouraging regular hemostatic monitoring, enabling fast delivery of blood component and/or tranexamic acid.
Historically, surgery has continued for more than two millennia. The first known descriptions come from the sixth century BC when Sushruta, an Indian physician surgeon, performed cosmetic surgery. However, despite this, until recently there was only limited research as to the best ways to manage patients with intraoperative and postoperative bleeding. The description of the risk of venous thromboembolism being greatly increased after surgery is a relatively new phenomenon in comparison, as most of the documentation is from the 1970s onward.
There are many unanswered questions in relation to the best management to prevent and manage perioperative thrombosis and hemostasis. However, we hope this will change quickly with the many current international research programs dedicated to this area and also the establishment of an International Society of Thrombosis and Hemostasis subcommittee that focuses on this area. We are both proud to be founding members of the organizing committee and are thrilled and excited by the overflowing attendance at the meetings we have held, reflecting the interest in this subject.
We have therefore commissioned a set of articles to reflect current best practice in thrombosis and hemostasis in the many different types of surgery now available. We have enjoyed reading and editing them and hope they will encourage more enthusiasm and research in this rapidly-growing area.
- 1 Sushruta: the ancient Indian surgeon. Available at: https://hekint.org/2017/01/22/sushruta-the-ancient-indian-surgeon/ . Accessed October 30, 2019
- 2 Abeysiri S, Chau M, Richards T. Perioperative anemia management. Semin Thromb Hemost 2020; 46 (01) 8-16
- 3 Mensah PK, Pavord S. Managing preoperative haemostatic disorders in patients with inherited and acquired bleeding disorders. Semin Thromb Hemost 2020; 46 (01) 17-25
- 4 Nikolakopoulos I, Spyropoulos AC. Heparin Bridging Therapy for Patients on Chronic Oral Anticoagulants in Periprocedural Settings. Semin Thromb Hemost 2020; 46 (01) 26-31
- 5 Levy JH, Ghadimi K, Waldron NH, Connors JM. Using plasma and prothrombin complex concentrates. Semin Thromb Hemost 2020; 46 (01) 32-37
- 6 Grottke O, Mallaiah S, Karkouti K, Saner F, Haas T. Fibrinogen supplementation and its indications. Semin Thromb Hemost 2020; 46 (01) 38-49
- 7 Thiele T, Greinacher A. Platelet transfusion in perioperative medicine. Semin Thromb Hemost 2020; 46 (01) 50-61
- 8 Fang ZA, Navaei A, Hensch L, Hui SK, Teruya J. Hemostatic management of extracorporeal circuits including cardiopulmonary bypass & extracorporeal membrane oxygenation. Semin Thromb Hemost 2020; 46 (01) 62-72
- 9 Curry N, Brohi K. Surgery in traumatic injury and perioperative considerations. Semin Thromb Hemost 2020; 46 (01) 73-82
- 10 Samama CM. Postoperative venous thromboembolism prophylaxis: changes in the daily clinical practice, modified guidelines. Semin Thromb Hemost 2020; 46 (01) 83-88
- 11 Iba T, Levi M, Levy JH. Sepsis-induced coagulopathy and disseminated intravascular coagulation. Semin Thromb Hemost 2020; 46 (01) 89-95
- 12 Mihalko E, Brown AC. Clot structure and implications for bleeding and thrombosis. Semin Thromb Hemost 2020; 46 (01) 96-104