Table 8.
—Risk Factors for Major Bleeding Complications
| General risk factors |
| Active bleeding |
| Previous major bleeding |
| Known, untreated bleeding disorder |
| Severe renal or hepatic failure |
| Thrombocytopenia |
| Acute stroke |
| Uncontrolled systemic hypertension |
| Lumbar puncture, epidural, or spinal anesthesia within
previous 4 h or next 12 h |
| Concomitant use of anticoagulants, antiplatelet therapy,
or thrombolytic drugs |
| Procedure-specific risk factors |
| Abdominal surgery |
| Male sex, preoperative hemoglobin level < 13
g/dL, malignancy, and complex surgery defined as two or more
procedures, difficult dissection, or more than one
anastamosis89 |
| Pancreaticoduodenectomy |
| Sepsis, pancreatic leak, sentinel
bleed87 |
| Hepatic resection |
| Number of segments, concomitant extrahepatic organ
resection, primary liver malignancy, lower preoperative
hemoglobin level, and platelet counts88 |
| Cardiac surgery |
| Use of aspirin90 |
| Use of clopidogrel within 3 d before
surgery91 |
| BMI > 25 kg/m2, nonelective surgery,
placement of five or more grafts, older
age92 |
| Older age, renal insufficiency, operation other than
CABG, longer bypass time93 |
| Thoracic surgery |
| Pneumonectomy or extended
resection94 |
| Procedures in which bleeding complications may have especially
severe consequences |
| Craniotomy |
| Spinal surgery |
| Spinal trauma |
| Reconstructive procedures involving free flap |
CABG = coronary artery bypass graft.