A Prospective Evaluation of the Efficacy of Preoperative Coagulation Testing

Abstract

The efficacy of routine screening coagulation tests was studied to identify occult coagulopathies in patients prior to elective general and vascular surgery procedures. The efficacy of screening tests was compared to that of indicated tests performed for predefined clinical indications, which were elicited by history and physical examination and a detailed coagulation history questionnaire. Tests were prothrombin time (PT), partial thromboplastin time (PTT), platelet count (PC), and bleeding time (BT). Of 514 screening tests done in the 282 patients, 4.1% were abnormal, but none of them identified a clinically significant coagulopathy. Of the 605 indicated tests, 7.4% were abnormal, and all significant coagulopathies were found in this group. The study shows that preoperative screening tests for coagulopathies not suspected on the basis of detailed clinical information are unnecessary and should not be done. In the authors' institution 46% of screening coagulation tests could be eliminated.

Perkütan Transtorasik Akciger ve Kemik Biyopsileri

“…Pek çok çalışmada ayrıntılı klinik değerlen-dirme sonucunda şüphe yoksa hastalarda biyopsi öncesi koagülogülasyon parametrelerine bakılmasının gerekli olmadığı belirtilmektedir [7]. Ancak riskleri minimize etmek amacıyla biyopsi öncesi rutin kanama parametrelerine bakılmalıdır (INR<1.5, trombosit sayısı> 50000).…”

A Prospective Evaluation of Preoperative Screening Laboratory Tests in General Surgery Patients

“…For example, patients with lupus anticoagulant and those with contact factor deficiency, such as factor xii, do not have a bleeding tendency in spite of a prolonged PTT [6,7]. The maximum number of unexpected abnormalities in INR was 1.4, and, in general, an INR level less than 1.5 is acceptable for elective general surgical procedures [11][12][13].…”

Cuestionario de sangrado preoperatorio en pacientes sometidos a amigdalectomía y/o adenoidectomía

“…El cuestionario tuvo mayor capacidad de detectar sangrado posoperatorio pero, con un bajo porcentaje (24%). La mayoría de los pacientes que presentaron sangrado posoperatorio tuvieron exámenes y cuestionario normal, por lo que es necesario buscar otros factores que expliquen el sangrado, no existiendo en la actualidad buenos elementos de predicción de su presencia en el posoperatorio [23][24][25][26][27][28][29][30] . Existe controversia en la literatura respecto a realizar exámenes preoperatorios llamados "de rutina" en pacientes sin antecedentes clínicos que hagan sospechar una alteración de la coagulación.…”