$ATHX In major surgery, a common complication is hyperfibrinolysis (110). According to the STS database, up to 50% of cardiac surgery patients require blood product transfusions (111), and 5–7% will lose in excess of 2 l in the first day postoperatively (112, 113). About 50% of blood loss is due to identifiable surgical bleeding, and the other 50% is due to a hypocoagulopathy associated with surgical trauma, heparinization, and CPB (112, 113). Surgical hypothermia further exacerbates hemorrhagic, cardiovascular, and infectious complications compared to normothermia (114). In non-cardiac surgery, coagulopathic perioperative bleeding is also a major problem. In a recent prospective, multicenter observational cohort study of 1134 consecutive patients with coronary stents, 9.5% experienced postoperative hemorrhagic complications after non-cardiac surgery, and 12% of these died (115).
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