A 52 yr old patient presents to the Emergency Department with acute coronary syndrome and cardiogenic shock. He receives 300mg aspirin, 600mg clopidogrel and a tirofiban infusion is initiated. The angiogram shows left main stem occlusion– and he is referred urgently to cardiac surgery. The tirofiban infusion is ceased. On return from theatre, there is 400ml/ hr blood loss for the first 3 hours.
13.1 List 5 causes of early post-operative bleeding in this patient.
1 Surgical bleeding
3 Inadequate reversal of heparinisation
4 Pre-existing platelet dysfunction - pharmacological or pathological
5 Dilutional coagulopathy
6 Thrombocytopoenia - due to trauma of bypass circuit
This question closely resembles Question 13 from the 1st paper of 2012.
Bleeding complications following coronary artery bypass grafting and complications attributed to the cardiopulmonary bypass circuit are abundantly explored elsewhere.