Original Article

Is It Rational to Study Coagulations Test Routinely before Operations and Invasive Procedure: Single Center Retrospective Study

Abstract

Background: Detailed history taking, physical examination and laboratory tests are useful tools to document any abnormal bleeding risk before an operation or an invasive procedure. Although coagulation tests are routinely used to demonstrate the pathological situations at the coagulation cascade or to follow-up the anticoagulation therapies, their role in determining the bleeding risk in preoperative patients is controversial.
Materials and Methods: In this study, we aimed to evaluate the patients referring to our hematology clinic at Izmir Katip Celebi University Hospital for preoperative consultation due to elevated levels of coagulation tests.
Results: Fifty-six patients with high PT/PTT levels were enrolled in this study. Twenty-six (46.4%) patients were male and 30 (53.6%) were female. The median age was 34 (18-75) years. We documented bleeding history in 12 (21.4%) patients. The patients having a bleeding history revealed mostly abnormal uterine bleeding, epistaxis, and gingival bleeding. Life threatening bleeding was not reported in any of the patients.  The operations were cancelled or postponed at least one month in 38 (67.8%) and 10 (17.8%) patients, respectively. Per-operative or post-operative abnormal bleeding was not documented. We did not find any statistically significant difference between groups with or without elevated coagulation tests in terms of abnormal bleeding in the operations.
Conclusion: Coagulations tests should be studied in selected group of patients. Additionally, mildly elevated results should be interpreted carefully to decrease the rate of cancellation and delay in operations and unnecessary increase in costs.

 

 

1. Bonhomme F, Boehlen F, Clergue F, et al. Preoperative hemostatic assessment: a new and simple bleeding questionnaire. Can J Anaesth. 2016;63(9):1007-15
2. Chee YL, Crawford JC, Watson HG, et al. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Committee for Standards in Haematology. Br J Haematol. 2008; 140(50): 496-504.
3. Bonhomme F, Ajzenberg N, Schved JF, et al. Pre-interventional haemostatic assessment: Guidelines from the French Society of Anaesthesia and Intensive Care. Eur J Anaesthesiol. 2013; 30(4): 142-62.
4. Houry S, Georgeac C, Hay JM, et al. A prospective multicenter evaluation of preoperative hemostatic screening tests. The French Associations for Surgical Research. Am J Surg. 1995; 170(1):19–23.
5. Licameli GR, Jones DT, Santosuosso J, et al. Use of a preoperative bleeding questionnaire in pediatric patients who undergo adenotonsillectomy. Otolaryngol Head Neck Surg. 2008; 139(4): 546-550.
6. Music I, Novak M, Acham-Roschitz B, et al. Screening for haemorrhagic disorders in paediatric patients by means of a questionnaire. Hamostaseologie. 2009; 29 Suppl 1: S87-9.
7. Bajaj Spö, Joist JH. New insights into how blood clots: implication for use of APTT and PT as coagulation screening tests and in monitoring of anticoagulant therapy. Semin Thromb Hemost. 1999; 25(4):407-18.
8. Gezer S, Koagülasyon testlerinin klinikteki kullanımı. Hemostaz. Hematolog, Ağustos 2012, 2.2
9. Kussmann I, Koller M, Heinke T, et al. [Value of preoperative blood coagulation analysis for assessment of hemorrhage risk in general surgery]. Chirurg. 1997; 68(7):684-8.
10. Cosmi B, Alatri A, Cattaneo M, et al. Assessment of the risk of bleeding in patients undergoing surgery or invasive procedures: Guidelines of the Italian Society for Haemostasis and Thrombosis (SISET). Thromb Res. 2009; 124(5):e6-e12.
11. Kozek-Langenecker SA. Perioperative coagulation monitoring. Best Pract Res Clin Anaesthesiol. 2010; 24(1):27-40.
12. Munro J, Booth A, Nicholl J. Routine preoperative testing: a systematic review of the evidence. Health Technol Assess. 1997; 1(12):i–iv, 1–62.
13. Gün T. Elektif cerrahide rutin preoperatif koagülasyon testlerinin yeri. Ortadoğu Tıp Dergisi. 2018; 10 (2): 115-118.
14. Segal JB, Dzik WH, Transfusion Medicine/Hemostasis Clinical Trials Network. Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: an evidence-based review. Transfusion. 2005; 45(9):1413-25.
15. Burk CD, Miller L, Handler SD, et al. Preoperative history and coagulation screening in children undergoing tonsillectomy. Pediatrics. 1992; 89 (4 Pt 2):691-5.
16. Gabriel P, Mazoit X, Ecoffey C. Relationship between clinical history, coagulation tests and perioperative bleeding during tonsillectomies in pediatrics. J Clin Anesth. 2000; 12(4): 288–91.
17. Chee YL, Greaves M. Role of coagulation testing in predicting bleeding risk. Hematol J. 2003; 4(6):373-8.
18. Rafiq S, Johansson PI, Kofoed KF, et al. Preoperative hemostatic testing and the risk of postoperative bleeding in coronary artery bypass surgery patients. J Card Surg. 2016; 31(9):565-71.
19. Takita K, Yamazaki Y, Morimoto Y. Are routine preoperative hemostatic screening tests necessary in Japanese institutions? J Anesth. 2013; 27(3):481–2.
Files
IssueVol 13, No 3 (2019) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijhoscr.v13i3.1272
Keywords
Coagulation test; PT/INR; aPTT; Preoperative

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Yılmaz F, Karslı T, Kiper D, Gediz F, Payzın B. Is It Rational to Study Coagulations Test Routinely before Operations and Invasive Procedure: Single Center Retrospective Study. Int J Hematol Oncol Stem Cell Res. 2019;13(3):140-145.