Post-Operative Bleeding: Causes, Risks, and Prevention

Post-operative bleeding etiologies (approximate distribution):

1. Failure of hemostasis before wound closure (~70%): Inadequate ligation, cauterization, or missed vessels.
2. Drug-induced coagulopathy (~20%): Antiplatelets, anticoagulants, thrombolytics; hepatic dysfunction reducing factor synthesis.
3. Disseminated Intravascular Coagulation (~10%): Consumptive coagulopathy from sepsis, trauma, malignancy, obstetric complications.

Additional Factors

• Hypertension (uncontrolled)
• Hereditary bleeding disorders (von Willebrand, hemophilia)
• Platelet dysfunction (uremia, aspirin)
• Surgical technique (raw surfaces, vascular beds)
• Fibrinolysis activation

Prevention

• Pre-op: review/hold antithrombotics per guidelines, screen bleeding history, correct coagulopathy.
• Intra-op: meticulous hemostasis, topical agents (fibrin sealant, Surgicel), hypotensive anesthesia if appropriate.
• Post-op: monitor vitals, drains, labs; early re-exploration if indicated.

Prompt recognition and targeted correction (factor replacement, platelet transfusion, surgical re-exploration) are critical.