TY - JOUR
T1 - Preoperative screening for bleeding disorders
T2 - A comprehensive laboratory assessment of clinical practice
AU - Vries, Minka J.
AU - van der Meijden, Paola E.
AU - Kuiper, Gerhardus J.
AU - Nelemans, Patricia J.
AU - Wetzels, Rick J.
AU - van Oerle, Rene G.
AU - Lance, Marcus D.
AU - ten Cate, Hugo
AU - Henskens, Yvonne M.
PY - 2018/10
Y1 - 2018/10
N2 - 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.
AB - 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.
KW - bleeding disorders
KW - diagnostic techniques
KW - ISTH-Bleeding Assessment Tool
KW - preoperative management
KW - COAGULATION DISORDERS
KW - DIAGNOSIS
KW - MANAGEMENT
KW - GUIDELINES
KW - QUESTIONNAIRE
KW - CONSENSUS
KW - SOCIETY
KW - PATIENT
KW - RISK
U2 - 10.1002/rth2.12114
DO - 10.1002/rth2.12114
M3 - Article
C2 - 30349896
SN - 2475-0379
VL - 2
SP - 767
EP - 777
JO - Research and practice in thrombosis and haemostasis
JF - Research and practice in thrombosis and haemostasis
IS - 4
ER -