Preoperative screening for bleeding disorders: A comprehensive laboratory assessment of clinical practice

Minka J. Vries*, Paola E. van der Meijden, Gerhardus J. Kuiper, Patricia J. Nelemans, Rick J. Wetzels, Rene G. van Oerle, Marcus D. Lance, Hugo ten Cate, Yvonne M. Henskens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

17 Citations (Web of Science)

Abstract

Background: Patients with mild bleeding disorders are at risk of perioperative bleeding, but screening for these disorders remains challenging.

Objectives: We aimed to assess the prevalence of hemostatic abnormalities in patients with and without reported bleeding symptoms on a preoperative questionnaire, consisting of guideline-proposed questions, and appraised the diagnostic value of several screening modalities for the identification of patients with hemostatic abnormalities.

Methods: In this observational study, 240 patients with and 95 patients without bleeding symptoms on the preoperative questionnaire were included. Patients with known bleeding disorders, antithrombotic drugs, thrombocytopenia, and anemia were excluded. Preoperatively, all patients underwent elaborate hemostatic testing. Hemostatic abnormalities were defined as coagulation, vWF, or fibrinolysis factor levels below reference range and platelet function defects. Screening modalities included the ISTH Bleeding Assessment Tool (ISTH-BAT), PT, aPTT, TT, Euglobulin Lysis Time (ELT), and Platelet Function Analyser (PFA).

Results: In 21 of 240 (8.8%) patients reporting bleeding symptoms, hemostatic abnormalities were found, including 7 reduced coagulation factor levels, 10 platelet function abnormalities, and 4 reduced vWF levels. In comparison, 10 of 95 (10.5%) patients not reporting bleeding symptoms had abnormalities. The ISTH-BAT could not identify patients with abnormalities, while PT, aPTT, TT, ELT, and PFA had high specificity but low sensitivity to detect abnormalities.

Conclusions: The prevalence of hemostatic abnormalities in both patients with and without reported bleeding symptoms was 9%-10%. This suggests that the guideline-based questionnaire cannot differentiate between patients with and without abnormalities, while the discriminative power of the screening modalities is also limited.

Original languageEnglish
Pages (from-to)767-777
Number of pages11
JournalResearch and practice in thrombosis and haemostasis
Volume2
Issue number4
DOIs
Publication statusPublished - Oct 2018

Keywords

  • bleeding disorders
  • diagnostic techniques
  • ISTH-Bleeding Assessment Tool
  • preoperative management
  • COAGULATION DISORDERS
  • DIAGNOSIS
  • MANAGEMENT
  • GUIDELINES
  • QUESTIONNAIRE
  • CONSENSUS
  • SOCIETY
  • PATIENT
  • RISK

Cite this