Cardiovascular surgery

Withdrawal of aspirin therapy increases the risk of coronary thrombosis; continuation of aspirin therapy increases the risk of bleeding. B

Withdrawal of clopidogrel therapy increases the risk of coronary thrombosis; continuation of clopidogrel therapy increases the risk of bleeding. A

We recommend prophylactic administration of tranexamic acid before CPB in patients undergoing coronary artery bypass grafting (CABG) surgery. 1A

We suggest tranexamic acid can be applied topically to the chest cavity to reduce postoperative blood loss following cardiac surgery. 2C

In complex cardiovascular surgery we recommend fibrinogen concentrate infusion guided by VHA monitoring to reduce perioperative blood loss. 1B

We suggest that rFVIIa may be considered for patients with intractable bleeding during and after cardiovascular surgery once conventional haemostatic options have been exhausted. 2B

We suggest that antiplatelet therapy with aspirin or clopidogrel may be administered in the early postoperative period without increasing the risk of postoperative bleeding. 2C

We recommend the use of standardised VHA-guided haemostatic algorithms with pre-defined intervention triggers. 1B