Postoperative bleeding

In the postoperative diffuse bleeding scenario any therapeutic effort is ba sed on the assumption that there is no surgical means to stop bleeding. The diagnosis of the underlying mechanism differentiates a static from a dynam ic haemostatic disorder. Whereas the static coagulation disorder is charact erised by a decreased procoagulant and inhibitory coagulation potential whi ch is stable (most likely :dilution), the dynamic haemostatic disorder refl ects ongoing consumption of both coagulation factors and inhibitors due to blood loss or permanent activation. Global coagulation variables such as th e prothrombin time, the activated partial thromboplastin time, fibrinogen c oncentration, platelet count, and antithrombin (AT) activity may indicate w hether there is an increased turnover (progressive deterioration of all var iables) or not. In order to avoid further deterioration of a static coagula tion disorder when the patient is bleeding diffusely; fresh frozen plasma ( FFP) should ideally be used to maintain plasmatic coagulation activity duri ng red cell transfusion therapy Increased turnover, however, should primari ly be treated by coagulation inhibitor concentrates such as AT III, in part icular prior to administration, of coagulation factor (platelets, prothromb in complex, fibrinogen).