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Perioperative bleeding is a dreaded surgical complication. More often than not you will hear, “It was dry when we closed…” as your surgical colleagues struggle to identify the source. Hospitalists are often involved in managing patients before and after surgery, hence they need a good working knowledge of how to predict, evaluate, and manage perioperative bleeding. This chapter will focus on the preoperative evaluation of bleeding risk, intraoperative risk factors for bleeding, typical presentations of postoperative bleeding, and how a hospitalist needs to evaluate and manage the bleeding.


To identify patients at increased risk of perioperative bleeding complications, inquire about any history of bleeding problems, such as a known bleeding diathesis, excessive bleeding from minor trauma, menorrhagia, gingival bleeding, hemarthoses, excessive bruising, petechiae, liver, or renal disease. Review medications that can affect normal coagulation, such as antiplatelet agents and anticoagulants, and review the risks and benefits of stopping these agents with the surgeon. All patients identified with risk factors for bleeding should have preoperative laboratory evaluations including a complete blood count, liver function tests, chemistry panel, prothrombin time (PT), activated partial prothrombin time (aPTT), and international normalized ratio (INR). The laboratory test results should be interpreted based on the information in Table 43-1.

TABLE 43-1Expected Laboratory Results by Type of Bleeding Disorder

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