Assessing Bleeding Risk Prior to Surgery (2008)


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.

à 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 à will miss mild haem A / VWD


Or maybe abnormal in a healthy patient

-       E.g. FXII deficiency, Lupus Anticoagulant