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

 

Notes

 

‘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