PFA-100 closure times in preoperative screening in 500 pediatric patients

Abstract

Three to five percent of patients undergoing surgery have either an acquired or congenital platelet defect or von Willebrand disease (vWD). The predictive value of preoperative coagulation screening is questionable. PFA-100 is now routinely used in preoperative screening in our pediatric outpatient service. We wanted to assess whether the PFA-100 would help to identify patients with primary haemostatic defects or if the additional use of PFA-100 would add to the problem of unnecessary pathologic preoperative laboratory values resulting in delay of surgical procedure. We investigated 500 children consecutively seen in our outpatient service before surgery. Blood cell count, aPTT, PFA-100 closure times (CT) were done in all patients. If abnormalities were found, the patient was presented to a haemostatic expert. vWF:AG, R:Cof and factor VIII were analysed in all patients with prolonged closure times and APTT values. One hundred twenty-six patients (25.2%) showed abnormalities in APTT and/or PFA-100. Further investigations in 89 of these 126 patients did not yield a specific diagnosis; neither diagnostic criteria for impaired haemostasis were found by questionnaire. None of these 89 patients had a bleeding complication during surgery. Forty-eight patients showed prolonged CTs. Twelve patients with low vWF:AG were detected, 10 of these patients were found by PFA-100. Four of these patients did present with normal APTT values. Our study shows that similar to the APTT the PFA-100 is probably only a good screening method when a haemostatic defect in a patient is clinically likely, especially to screen forVWD, and the test should not be used in general unselective screening.

Utility of preoperative in vitro platelet function tests for predicting bleeding risk in patients undergoing functional endoscopic sinus surgery

“…Although the frequency of bleeding episodes was higher (17.6%) in patients with prolonged CT-epi values than in patients with prolonged PT, INR or aPTT in the present study, there was no statistical difference between patients with prolonged CT-epi values and patients with normal CT-epi values ( P =0.171). Results of the present study are similar to those of the earlier study, which reported that CT values are not necessary in general unselective screening 17. It has been reported that the PFA-100 result during the perioperative period cannot predict the intensity of perioperative bleeding in patients undergoing neurosurgery, heart surgery or hemiarthroplasty 18–20.…”

Perioperative Coagulation Management and Control of Platelet Transfusion by Point-of-Care Platelet Function Analysis

“…In addition, preoperative correction of impaired haemostasis results in a reduction of bleeding complications and homologous blood transfusions [56]. On the other hand, the study of Roschitz et al [57] shows that the PFA-100 is probably only a good screening method when a haemostatic defect in a patient is clinically likely, especially to screen for von Willebrand syndrome, and the test should not be used in general unselective screening without positive bleeding history. Based on the above mentioned studies and consensus of experts, the scientific committee of the Deutsche Gesellschaft für Anästhesie und Intensivmedizin (DGAI) in agreement with the Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf-und Hals-Chirurgie (DGHNOKC) and the Gesellschaft für Thrombose-und Hä-mostaseforschung (GTH), as well as with the subcommittee for perioperative coagulation of the Österreichische Gesellschaft für Anaesthesiologie, Reanimation und Intensivmedizin (ÖGARI) recommend the use of a standardized questionnaire to detect an increased risk of bleeding [58,59].…”

“…Therefore, the test should not be used in general unselective screening without positive bleeding history [54,57,58,91,92]. Furthermore, the limitations in drug monitoring for clopidogrel and GPIIb/IIIa receptor inhibitors have to be kept in mind.…”

The role of PFA‐100 measurement in preoperative screening in total knee arthroplasty patients with perioperative replacement of cyclooxygenase‐2 inhibitor

“…Koscielny et al [8] reported that PFA-100 analysis as a screening test could detect impaired hemostasis in 5649 adult patients, whereas Roschitz et al [9] concluded that this test should not be used in general unselective screening. The preoperative evaluation of platelet function before TKA has been limitedly investigated.…”