What is non-surgical bleeding?

From the Guidelines

Non-surgical bleeding refers to any blood loss that is not related to a surgical procedure, and its management depends on the cause and severity of the bleeding, with treatment options ranging from observation to medication interventions and hemodynamic stabilization. According to the most recent and highest quality study, 1, non-surgical bleeding can be categorized into major and non-major bleeds based on the presence of certain factors such as bleeding at a critical site, hemodynamic instability, or clinically overt bleeding with a significant hemoglobin decrease. Some key points to consider in the management of non-surgical bleeding include:

• Prompt identification of the bleeding source
• Assessment of the severity of the bleeding
• Use of local measures such as pressure or cold compresses for minor bleeding
• Administration of medications such as tranexamic acid, aminocaproic acid, or specific factor replacements for bleeding disorders
• Systemic treatments such as vitamin K for warfarin reversal, protamine sulfate for heparin reversal, or platelet transfusions for thrombocytopenia
• Hemodynamic stabilization with intravenous fluids or blood products in severe cases. It is also important to note that the management of non-surgical bleeding may vary depending on the underlying cause and the patient's individual circumstances, and that the use of reversal agents such as idarucizumab for dabigatran or andexanet alfa for apixaban or rivaroxaban may be necessary in certain situations, as suggested by 1. Additionally, the study by 1 provides a comprehensive classification system for bleeding, which can be useful in guiding the management of non-surgical bleeding. Overall, the management of non-surgical bleeding requires a careful and individualized approach, taking into account the underlying cause and severity of the bleeding, as well as the patient's overall clinical condition.

From the FDA Drug Label

Non-surgical bleeding episodes

43 non-surgical bleeding episodes 10 non-surgical bleeding episodes 8 non-surgical, 68 non-surgical and 32 surgical bleeding episodes 8 non-surgical

Non-surgical bleeding refers to bleeding that is not related to surgery. In the context of the provided drug label, non-surgical bleeding episodes are mentioned as being treated with NOVOSEVEN, but the label does not provide a specific definition of non-surgical bleeding. 2

From the Research

Definition of Non-Surgical Bleeding

• Non-surgical bleeding refers to bleeding that occurs outside of a surgical setting, and can be caused by various factors such as trauma, medical conditions, or medications 3, 4.
• It can manifest as external bleeding, such as cuts or lacerations, or internal bleeding, such as bleeding in the gastrointestinal tract or brain 5.

Causes and Risk Factors

• Trauma, such as injuries from accidents or violence, is a significant cause of non-surgical bleeding 6, 5.
• Medical conditions, such as bleeding disorders, cancer, or liver disease, can also increase the risk of non-surgical bleeding 4.
• Certain medications, such as anticoagulants or antiplatelets, can also contribute to non-surgical bleeding 4.

Management and Treatment

• The management of non-surgical bleeding depends on the severity and cause of the bleeding, and may involve the use of tranexamic acid (TXA) or other hemostatic agents 6, 3.
• TXA has been shown to reduce mortality in trauma patients and is commonly used in the prehospital setting to control bleeding 6, 7.
• Other treatments, such as tourniquets, hemostatic dressings, and pressure dressings, may also be used to control bleeding in the out-of-hospital setting 5.