Postoperative bleeding

Fessenden JM, Wittenborn W, Clarke L. Ginkgo biloba a case report of herbal medicine bleeding postoperatively from a laparoscopic cholecystectomy. Ann Surg 2001 67 33-35. 

Fessenden, J.M., W. Wittenbom, and L. Clarke. 2001. Gingko biloba A case report of herbal medicine and bleeding postoperatively from a laparoscopic cholecystectomy Am. Surg. 67(l) 33-35. 

The patient should avoid salicylates for at least 1 week before any type of major or minor surgery, including dental surgery, because of the possibility of postoperative bleeding. In addition, the patient should not use the salicylates after any type of surgery until complete healing has occurred. The patient may use acetaminophen or an NSAID after surgery or a dental procedure, when relief of mild pain is necessary. 

If surgery or a dental procedure, such as tooth extraction or gum surgery, is anticipated, notify the primary health care provider or dentist. Salicylates may be discontinued 1 week before the procedure because of die possibility of postoperative bleeding. 

Use in surgical patients Avoid aspirin, if possible, for 1 week prior to surgery because of the possibility of postoperative bleeding. 

Coagulative effect. Permixon, administered to 108 patients at a dose of 320 mg/ day for at least 8 weeks before the procedure of transurethral resection of prostate, produced significantly lower bleeding than in the control (124 vs 287 mL, respectively), and the need of transfusion decreased remarkably. The duration of postoperative catheterization (3 vs 5 days, respectively) and the evaluated hematological parameters (red cells 4.5 vs 4 million, hemoglobin 13.4 vs 11.9 g, hematocrit 40 vs 35%) were significantly lower than in the control group . 

Unlabeled Uses Prevention of aspiration pneumonia, treatment of recurrent postoperative ulcer, upper GI bleeding, prevention of acid aspiration pneumonitis during surgery, prevention of stress-induced ulcers. 

Burham BE. Garlic as a possible risk for postoperative bleeding. Blast Reconstr Surg 1995 95 213. 

Fremes SE, Wong BI, Lee E, Mai R, Christakis GT, McLean RF, Goldman BS, Naylor CD. Metaanalysis of prophylactic drug treatment in the prevention of postoperative bleeding. Ann Thorac Surg 1994 58(6) 1580-8. 

Warfarin Garlic (Allium sativum) Increased INR Postoperative bleeding and spontaneous spinal epidural hematoma have been reported with garlic alone garlic causes platelet dysfunction... 

May cause easy bruising and excessive bleeding from minor injuries. Reports of haemorrhage with concomitant use of warfarin and dan shen. INR may not always be altered. Case report with ginseng of normal coagulation studies during postoperative bleeding... 

Most patients having cataract extraction are elderly, and some may have bleeding disorders. Because acetaminophen and the nonacetylated salicylates affect platelet aggregation only minimally, these analgesics are preferred for preoperative or postoperative use. 

For the past few decades, heparin has been widely used for the prevention of postoperative thiomboemboUsm (6,7). However, there are several adverse side-effects associated with the use of heparin such as bleeding, heparin induced thrombocytopenia, heparin induced thrombosis (8,9) and osteoporosis (10). In addition, the regimen of pioph actic heparin used in the prevention of deep venous thrombosis (DVT) is tedious, requiring 2 to 3 daily injections because of the limited bioavailability and short half-life of heparin when administered subcutaneously. 

Of the many drugs used as prophylactic antithrombotic agents, heparin has a long history as therapy for both DVT and pulmonary embolism (PE). Many studies have shown that in moderate and high risk patients, heparin can prevent postoperative DVT and PE (4,19-21). Now, with the introduction of LMWHs, these benefits can be had together with easier dosing and potentially less risk of bleeding. 

Dextrans, particularly of MW 70 000 (dextran 70), alter platelet function and prolong the bleeding time. Dextrans differ from the other antiplatelet drugs which tend to be used for arterial thrombosis dextran 70 reduces the incidence of postoperative venous thromboembolism if it is given during or just after surgery. The dose should not exceed 10% of the estimated blood volume. They are rarely used. 

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