Preventing, minimizing, and managing postoperative bleeding

Background. Most bleeding in cardiovascular surgery is biological, not surg ical, the result of disseminated intravascular coagulation in its latter ph ases. Disseminated intravascular coagulation bleeding affects all levels of the coagulation systems, requiring stabilization of the platelet system, b alancing the procoagulant system and its regulation, and stopping the fibri nolytic system's activation. Methods. The article discusses the multisystem protocol put into place at t he Cardiovascular Surgery Department of La Pitie Hospital in Paris to diagn ose and treat DIC bleeding so as to slow down causes of its occurrence and prevent further deterioration of the hemostatic systems. Results. All biological bleeding was controlled, permitting detection of ot her causes of bleeding and allowing rational use of blood products. No thro mboembolic accident occurred. There was an absence of iatrogenic bleeding. The protocol also detects disseminated intravascular coagulation in patient s who did not bleed to take early and frequently lifesaving measures. Conclusions. This demonstrates the need to treat bleeding through a multisy stem approach, monitoring its evolution by means of biological tests to be able to provide appropriate treatment. (C) 1999 by The Society of Thoracic Surgeons.