Role of coagulation testing in predicting bleeding risk.
Coagulation testing is employed widely prior to open surgery and invasive procedures. This is based on the assumption that such testing is of clinical value in the prediction of bleeding. In order to improve the clinical understanding of the potential limitations of first-line coagulation tests used in this way, we have systematically reviewed the literature that addresses the value of routine coagulation testing in helping to predict bleeding risk. We conclude unreservedly that indiscriminate coagulation testing is not useful in a surgical or a medical setting. This is due to the limited sensitivity and specificity of the tests, coupled with the low prevalence of bleeding disorders resulting in a high number of false positives, poor positive predictive value for bleeding and numerous false negatives resulting in false reassurance. Since most abnormal results can be predicted and most cases of significant bleeding disorder identified from a complete clinical assessment, the employment of selective laboratory testing is more cost-effective and represents evidence-based clinical practice.
Chee
Yen-Lin
YL
Department of Medicine and Therapeutics, University of Aberdeen, Foresterhill, Aberdeen, Scotland, UK.
Greaves
Michael
M
D000328:Adult; D001780:Blood Coagulation Tests; D002648:Child; D006470:Hemorrhage / Q000453:epidemiology*; D006801:Humans; D010314:Partial Thromboplastin Time; D011237:Predictive Value of Tests; D011517:Prothrombin Time; D015203:Reproducibility of Results; D012307:Risk Factors