Which of the following can increase the risk of postoperative bleeding after cardiac surgery?

Postoperative bleeding is a significant concern following cardiac surgery, and it can be influenced by several factors. Excessive use of anticoagulants is a well-documented risk factor; anticoagulants, by their nature, impair the blood's ability to clot, leading to an increased risk of bleeding. When used improperly or in excess, these medications can disrupt hemostasis, resulting in complications such as hematomas or more serious bleeding events.

Prolonged mechanical ventilation may also contribute to bleeding risks indirectly. Patients who require extended ventilation often have pre-existing conditions that can complicate their postoperative recovery, including potential complications related to coagulation. Additionally, prolonged ventilation can lead to increased intrathoracic pressure, which can affect hemostatic balance and promote bleeding.

The use of both internal mammary arteries during coronary artery bypass grafting is another factor that can elevate the risk of bleeding. While utilizing bilateral internal mammary arteries can offer improved long-term outcomes, it also increases the complexity of the procedure. This complexity can lead to additional trauma to surrounding tissues and increased risk of bleeding, particularly if there are variations in blood supply or technical issues during harvest and anastomosis.

By acknowledging that each of these factors contributes to an elevated risk of postoperative bleeding,