From the Guidelines

Yes, coagulation factors can be depleted after major surgery.

Coagulopathy and severe bleeding can occur after major surgery, particularly when cardiopulmonary bypass is involved 1.
Fibrinogen is a critical factor for hemostasis in the context of perioperative bleeding and is the first coagulation factor to fall to critically low levels during major hemorrhage 1.
A decrease in fibrinogen concentration is a predictor of the severity of the hemorrhage in trauma patients and with postpartum hemorrhage 1.

Normal plasma fibrinogen concentration ranges from 2 to 4 g L−1 1.
Fibrinogen levels can drop to critically low levels (<1.0 g L−1) during major hemorrhage 1.
A level of <2 g/l has a positive predictive value of 100% for progress toward severe bleeding during postpartum hemorrhage 1.

Fibrinogen concentrate can be used as a first-line treatment in bleeding patients, with an individualized and algorithm-based replacement strategy 1.
The efficacy of fibrinogen concentrates in stopping bleeding remains unproven, with conflicting results from small uncontrolled studies and randomized double-blind studies 1.
Viscoelastic tests can be used to guide fibrinogen administration, with some studies showing a decrease in postoperative bleeding and reduction in allogeneic blood product transfusions 1.

From the Research

Coagulation factors can be depleted after major surgery, as evidenced by studies that have investigated the changes in procoagulant factors in patients after major surgery 2, 3, 4.
On the first day after surgery, the majority of clotting factors, including factors II, VII, X, XI, and XII, have been shown to decrease significantly from baseline 2.
Factors II, X, XI, and XII can remain significantly reduced until the third day after surgery, while fibrinogen, factor VIII, and von Willebrand factor can increase starting on the second day after surgery 2.
The depletion of coagulation factors can be attributed to hemodilution and consumption of coagulation factors during surgery, as well as the inflammatory response and tissue destruction associated with surgical stress 5, 6.
The activity of individual coagulation factors can be affected differently after surgery, with some factors decreasing and others increasing, resulting in a complex coagulation profile 3, 4.

The type and extent of surgery can influence the degree of coagulation factor depletion, with more extensive surgery resulting in greater depletion 5.
Patient comorbidities, such as liver disease, sepsis, and hematological disorders, can also affect coagulation factor depletion and the risk of bleeding or thrombotic complications 5, 6.
The use of anticoagulants and antiplatelet drugs preoperatively can influence the response to surgical hemostasis and coagulation factor depletion 5.