RISK-FACTORS FOR BLEEDING IN MAJOR ABDOMINAL-SURGERY USING HEPARIN THROMBOPROPHYLAXIS

BACKGROUND: Patients undergoing major abdominal surgery are at risk of both bleeding and thrombotic complications and usually receive hepari n thromboprophylaxis. PATIENTS AND METHODS: Risk factors for periopera tive bleeding were examined in 3,809 patients in a double-blind, rando mized trial investigating heparin thromboprophylaxis. The risk factors were modeled by logistic regression, and a risk score was calculated using the significant factors in the model. RESULTS: Bleeding was asso ciated with the following factors in the model, given as adjusted odds ratios (ORa [95% confidence interval]): male sex (ORa 1.68 [1.21 to 2 .34] P = 0.003), malignancy (ORa 1.69 [1.21 to 2.34] P = 0.008), gynec ological surgery (ORa 1.62 [1.12 to 2.35] P = 0.011), and complex surg ery (ORa 2.7 [2.02 to 3.62] P < 0.001). The risk of excessive bleeding for 0, 1, 2, and 3 risk factors was 2%, 6%, 11%, and 21%, respectivel y. CONCLUSIONS: The recognition of patients with these risk factors as sociated with perioperative bleeding should result in increased vigila nce and may lead to modification of surgical and medical therapy. (C) 1997 by Excerpta Medica, Inc.