More Than Three-Quarters of Major Bleeding Events Occur Within 7 Days of Noncardiac Surgery

Major bleeding is a common and prognostically important postoperative complication, but the relative timing of bleeding events has not been well established. A new report in JAMA Network Open suggests that, among noncardiac surgery patients, more than three quarters of major bleeding events occurred within a week following surgery and nearly all took place within three weeks following surgery.

In this secondary analysis, investigators reviewed data from 39,813 adult patients aged 45 years or older who underwent inpatient noncardiac surgery as part of the VISION (Vascular Events in Noncardiac Surgery Patients Cohort Evaluation) study. The primary outcome was postoperative major bleeding, which included bleeding events resulting in transfusion, post-surgery hemoglobin levels below 7 g/dL, bleeding-related deaths and bleeding that necessitated additional intervention.

Investigators found that there were 5,340 major bleeding events in 4,638 patients within the first 30 days after surgery. Of these, 42.7% occurred within 24 hours of surgery, 77.7% by postoperative day 7, 88.3% by postoperative day 14 and 94.6% by postoperative day 21.

According to investigators, the findings provide insights for both clinical practice and research in noncardiac surgery. First, they noted that a better understanding of the timing of bleeding may help clinicians anticipate and prevent major bleeding events. Moreover, with regard to clinical trial design, the authors noted that an extended follow-up period may not be warranted, as most bleeding events occur soon after surgery. In addition, the authors concluded the findings may help clinicians to assess the risks and benefits associated with thromboprophylaxis and resuming medications after surgery.