ABSTRACT
Bleeding is a potential complication in any surgical or trauma patient. A major risk factor that increases the incidence of bleeding is anticoagulation. Lepirudin and Bivalirudin are derived from hirudin, an anticoagulant that was first derived from leeches. Most of the direct thrombin inhibitors cause non-linear prolongation of the partial thromboplastin time, and checking an ecarin clotting time or thrombin time may be preferable to ensure minimal anticoagulant effect before a procedure. Anticoagulant effect of rivaroxaban can be reversed with PCC, and tranexamic acid has been shown to reduce blood loss. Immunologic complications of blood transfusion are characterized as hemolytic and nonhemolytic. Several strategies exist to avoid blood transfusion altogether. Preoperative autologous donation was rarely used before the recognition that human immunodeficiency virus could be transmitted via blood transfusion. Aspirin is commonly used in the prevention and treatment of myocardial infarction, strokes, and occlusion of smaller caliber vascular grafts and stents.
