Perioperative bleeding

Perioperative bleeding represents a significant clinical challenge that impacts patient outcomes, prolongs recovery times and increases healthcare costs. This multifactorial condition arises from various causes, including surgical factors, coagulopathies, and the use of anticoagulants and antiplatelet agents. The management of perioperative bleeding is further complicated by the increasing use of novel anticoagulants and the presence of congenital or acquired bleeding disorders. This review discusses the pathophysiology of coagulation, the mechanisms contributing to perioperative bleeding, and current management strategies, particularly in patients undergoing anticoagulation therapy, while also exploring emerging technologies and therapies such as hemoadsorption devices, novel anticoagulant reversal strategies, point-of-care testing and evolving anticoagulant adsorbers. Overall, our findings highlight the critical need for individualized, evidence-based management strategies, and further research to optimize perioperative anticoagulation protocols and improve surgical outcomes.