Initial Appraisal of Hemostatic Impairment: General Overview and Immediate Concerns

It is of critical importance that clinicians who provide care to surgical patients understand the dynamic interplay of the coagulation and fibrinolytic systems. An appreciation for the relevant underlying biologic mechanisms is central to the diagnosis and appropriate management of patients who present with bleeding diatheses in both the operative and the postoperative setting. Surgery provides the most significant challenge to the integrity of the hemostatic system, and the fidelity of the coagulation system serves as the homeostatic defense mechanism that abrogates the proclivity for bleeding in this context.