Ecomment. Postoperative Bleeding without Re-exploration May Increase Opera- Tive Mortality Ecomment. Re: Re-exploration for Bleeding or Tamponade after Cardiac Operation

torial [2, 4]. Perioperative bleeding is related to surgical damage to blood vessels and defects in haemostatic mechanisms. The majority of haemostatic defects are related to the exposure of blood elements to the cardiopulmonary bypass circuit [2, 4]. Excessive administration of protamine is a proposed mechanism of bleeding [2]. It has been proved that CBP causes a reduction in the levels of coagulation factors, stimulates fibrinolysis and induces thrombocytopenia and platelet dysfunction [4]. The effects of circulating heparin and protamine must be considered [4]. Heparin rebound may be associated with postoperative bleeding [2]. The mechanism of the reappearance of heparin is the differential elimination of protamine vs. heparin [2]. On the basis of our results, we considered that patients undergoing valve procedures were more likely to undergo resternotomy (40.1%) for bleeding than patients undergoing coronary grafting (35.5%). We expect the influence of early postoperative use of warfarin—a vitamin K antagonist (warfarin, Orion Corporation, Espoo, Finland)—and Fraxiparin to cause early bleeding. On the basis of our experience, our current management in patients after aortic valve replacement with bioprothesis is using a 100 mg aspirin per day (acidum acetylsalicylicum, Zentiva, Slovak Republic) per os from the first postoperative day without higher risks of valve-related complications or valve thrombosis.