A practical concept for preoperative identification of patients with impaired primary hemostasis.
The findings of a large prospective study designed to identify primary and/or secondary hemostatic disorders before surgical interventions are presented. A total of 5649 unselected adult patients were enrolled to identify impaired hemostasis before surgical interventions. Each patient was asked to answer a standardized questionnaire concerning bleeding history. Activated partial thromboplastin time (aPTT), prothrombin time (PT), and platelet counts (PC) including PFA-100 (platelet function analyzer): collagen-epinephrine (C/E), and collagen-ADP (C/ADP) were routinely done in all patients. Additional tests, bleeding time (BT), and von Willebrand factor (vWF: Ag) were performed only in patients with a positive bleeding history and/or evidence of impaired hemostasis; e.g., drug ingestion. The bleeding history was negative in 5021 patients (88.8%) but positive in the remaining 628 (11.2%). Impaired hemostasis could be verified only in 256 (40.8%) of these patients. The vast majority were identified with PFA-100: C/E (n=250; 97.7%). The other six patients with impaired hemostasis were identifiable solely based on the PT (n=2), PFA-100: C/ADP (n=2), and vWF: Ag (n=2). The PFA-100: C/ADP detected 199 patients (77.7%). The only abnormality found among patients with a negative bleeding history was a prolonged aPTT due to lupus anticoagulant in nine patients (0.2%). The sensitivity of the PFA-100: collagen-epinephrine was the highest (90.8%) in comparison to the other screening tests (BT, aPTT, PT, vWF: Ag). The positive predictive value of the PFA-100: collagen-epinephrine was high (81.8%), but the negative predictive value was higher (93.4%). The use of a standardized questionnaire and, if indicated, the PFA-100: C/E and/or other specific tests not only ensure the detection of impaired hemostasis in almost every case but also a significant reduction of the cost.
Koscielny
Juergen
J
Institute for Transfusion Medicine, Charité Humboldt-University, Schumannstr. 20/21, 10117 Berlin, Germany. juergen.koscielny@charite.de
Ziemer
Sabine
S
Radtke
Hartmut
H
Schmutzler
Michael
M
Pruss
Axel
A
Sinha
Pranav
P
Salama
Abdulgabar
A
Kiesewetter
Holger
H
Latza
Reinhard
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000941:Antigens / Q000032:analysis; D001777:Blood Coagulation / Q000187:drug effects; D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D001780:Blood Coagulation Tests; D003094:Collagen / Q000494:pharmacology; D017558:Elective Surgical Procedures; D004837:Epinephrine / Q000494:pharmacology; D005260:Female; D005340:Fibrinogen; D006801:Humans; D008297:Male; D008403:Mass Screening; D008499:Medical Records; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D015539:Platelet Activation / Q000187:drug effects; D010979:Platelet Function Tests / Q000295:instrumentation; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D015995:Prevalence; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D019851:Thrombophilia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D014841:von Willebrand Factor / Q000276:immunology
D000941:Antigens; C029417:Von Willebrand antigen; D014841:von Willebrand Factor; D005340:Fibrinogen; D003094:Collagen; D004837:Epinephrine