Preoperative bleeding risk assessment in cardiac surgery patients

Abstract

Aim: To investigate the role of bleeding risk scores, personal and family medical history, and previous bleeding incidents in assessing the impact on the risk of all possible complications, including mortality, in adult patients following cardiac surgery.Methods. The search for publications was conducted using the PubMed, Transfusion Evidence Library, and eLibrary.ru databases, covering the period from 2019 to 2023. Search terms included: ‘bleeding risk assessment scales in adult cardiac surgery’, ‘preoperative anemia in adult cardiac surgery’, and ‘transfusion of red blood cell-containing components in cardiac surgery adults’. Duplicate articles were manually excluded. An additional search was performed among the reference lists of selected publications.Results. A total of 2,011 publications were found. In the first stage of selection, clinical studies, meta-analyses, randomized controlled trials, reviews, and regular reviews without language restrictions were considered based on the content of the abstract. In the second stage, for studies that passed the initial screening, decisions were made based on an assessment of the full-text versions, which presented the consequences of preoperative anemia, postoperative bleeding, and transfusion therapy in adult cardiac surgery patients. Ultimately, 40 publications were included in the review.Conclusion. Preoperative bleeding risk assessment is a multimodal, interdisciplinary challenge that necessitates a patient-centered approach. It should commence at the preparatory stage and involve primary care physicians, cardiologists, surgeons, anesthesiologists, laboratory diagnostic specialists, and transfusiologists. The cornerstone of this process is the thorough collection of individual and family medical histories. Obtaining detailed information through patient involvement, utilizing bleeding risk rating scales, reviewing previous bleeding incidents, and supporting these findings with laboratory test data represent the most scientific approach to developing an individualized management plan for patients at risk of bleeding.