Table of contents
Perioperative bleeding
What's new
Updated 2025 AoA guidelines for the management of perioperative bleeding .
Guidelines
Key sources
Diagnostic investigations
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Preoperative coagulation testing
Perioperative care
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Management of preoperative anemia (assessment and timing of surgery)
Management of preoperative anemia (thresholds)
Management of preoperative anemia (iron supplements and EPO-stimulating agents)
Management of preoperative anemia (RBC transfusion)
Management of antithrombotic therapy (aspirin)
Management of antithrombotic therapy (P2Y12 inhibitors)
Management of antithrombotic therapy (VKAs)
Management of antithrombotic therapy (DOACs)
Management of antithrombotic therapy (heparins)
Management of other therapies
Preoperative prophylactic platelet transfusion
Preoperative prophylactic plasma transfusion
Preoperative prophylactic vitamin K replacement
Intraoperative antifibrinolytics and cell salvage
Preoperative prophylactic tranexamic acid
Predeposit autologous donation
Perioperative fluid management
Intraoperative fluid management
Intraoperative transfusion
Management of bleeding related to antiplatelets
Management of bleeding related to heparins
Management of bleeding related to VKAs
Management of bleeding related to DOACs
Management of postoperative anemia (monitoring)
Management of postoperative anemia (iron supplements and EPO-stimulating agents)
Management of postoperative anemia (RBC transfusion)
Surgical interventions
Specific circumstances
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Critically ill patients
Patients with kidney disease
Patients with liver disease
Patients with COVID-19 infection
Patients with hereditary bleeding disorders (general principles)
Patients with hereditary bleeding disorders (hemophilia and vWD)
Patients with hereditary bleeding disorders (factor VII deficiency)
Patients with hereditary bleeding disorders (congenital dysfibrinogenemia)
Patients with hereditary bleeding disorders (platelet disorders)
Patients undergoing cardiac surgery (management of antiplatelets)
Patients undergoing cardiac surgery (monitoring)
Patients undergoing cardiac surgery (antifibrinolytics)
Patients undergoing cardiac surgery (transfusion)
Patients undergoing cardiac surgery (hemoadsorption and hemodilution)
Patients undergoing cardiac surgery (plasmapheresis)
Patients undergoing orthopedic surgery (surgical techniques)
Patients undergoing orthopedic surgery (antifibrinolytics)
Patients undergoing orthopedic surgery (blood transfusion)
Patients undergoing liver surgery (resection)
Patients undergoing liver surgery (transplantation)
Patients undergoing other visceral surgery
Patients undergoing gynecological surgery (management of preoperative anemia)
Patients undergoing gynecological surgery (tranexamic acid)
Patients undergoing gynecological surgery (misoprostol)
Patients undergoing gynecological surgery (blood transfusion)
Patients undergoing gynecological surgery (management of postoperative bleeding)
Patients undergoing neurosurgery
Patients undergoing interventional procedures (risk stratification)
Patients undergoing interventional procedures (preprocedural discontinuation of antiplatelet agents)
Patients undergoing interventional procedures (preprocedural discontinuation of anticoagulant agents)
Patients undergoing interventional procedures (resumption of antithrombotic therapy)
Patients undergoing interventional procedures (diagnosis of epidural hematoma)