Publications

Introduction

More than 300 million patients undergo surgery annually worldwide.1 Bleeding is among the most common surgical complications and is associated with blood transfusion, reintervention, organ injury, and death, as well as increased costs.2-4 Surgical patients often receive prophylactic or therapeutic anticoagulant and antiplatelet medications. Postoperative bleeding risk, which dissipates after surgery, is relevant for decisions about when to use these agents.

Understanding the risk and timing of postoperative bleeding is important for patient care for several reasons. For example, in addition to bleeding, patients undergoing surgery are at risk of thromboembolism and are, therefore, often prescribed thromboprophylaxis.5-10 The use of pharmacologic thromboprophylaxis involves a trade-off between a reduction in risk of venous thromboembolism (VTE) and increase in the risk of bleeding. Understanding of the timing of bleeding is critical for making decisions about the starting time and duration of pharmacologic prophylaxis, as well as to anticipate and prevent these complications.

To our knowledge, there are no systematic summaries on the timing of postoperative bleeding in surgery. We, therefore, undertook this secondary analysis of the large, international prospective VISION (Vascular Events in Noncardiac Surgery Patients Cohort Evaluation) study to determine the evolution of bleeding risk over time in the period immediately after major surgery.11 The results of this secondary analysis of the VISION study will also inform clinicians and practice guidelines when deciding on perioperative practices, including surgical thromboprophylaxis.