Assessing Bleeding Risk Prior to Surgery (bsh 2008)

key message

Patients with a negative bleeding history do not require laboratory screening


Consequences of unselected coag testing prior to surgery:

Delays surgery

Anxiety for patients

False reassurance to surgeon

Expensive and uses up lab time


All this, and it is a poor predictor of bleeding risk



‘Normal Range’ = 2 SD above and below the mean in disease-free subjects.

—> Therefore, 2.5% of disease-free subjects will have an abnormal result


Result may be normal in patients at risk of bleeding

  • E.g. Some APTT reagents only sensitive to FVIII <30 iu/dL —> will miss mild haem A / VWD

  • PT/APTT may be normal in patients taking direct oral anticoagulants


Or result maybe abnormal in a healthy patient

  • E.g. FXII deficiency, Lupus Anticoagulant