Postoperative bleeding in coronary surgery: any differences associated with sex?

Purpose: Postoperative bleeding is a critical concern in coronary artery bypass grafting (CABG), influencing patient outcomes and healthcare resources. This study evaluates sex-related differences in postoperative bleeding, transfusion requirements, and associated complications in CABG patients. Methods: A narrative review was conducted using studies assessing postoperative bleeding in male and female CABG patients. The literature was analyzed to identify variations in bleeding volume, transfusion needs, coagulation parameters, and clinical outcomes. Results: Postoperative bleeding in CABG results from a complex interplay of surgical, hematologic, and physiological factors. Risk factors include advanced age, preoperative antithrombotic use, anemia, hypertension, diabetes, and prolonged cardiopulmonary bypass (CPB) time. Women exhibit a higher prevalence of diffuse coagulopathy, anemia, and transfusion requirements, whereas men more frequently require surgical re-exploration for localized bleeding. Sex-based differences in endothelial function and pharmacologic management further impact outcomes. Optimizing perioperative strategies, including patient blood management, antifibrinolytic therapy, and individualized anticoagulation, is crucial to improving prognosis. Conclusion: Sex disparities in postoperative bleeding reflect physiological, anatomical, metabolic, and therapeutic differences. While women may have a lower risk of intraoperative bleeding, they are more vulnerable to hemorrhagic complications, anemia, and transfusion dependence, reinforcing the need for individualized perioperative management. Tailored strategies, including early risk stratification, optimized hemodilution, and personalized anticoagulation, are essential to reducing complications and improving outcomes. These findings highlight the importance of revising clinical guidelines to enhance the surgical care of women undergoing CABG.