A Practical Concept for Preoperative Identification of Patients with Impaired Primary Hemostasis

• Published in: Clinical and applied thrombosis/hemostasis 2004-07, Vol.10 (3), p.195-204
• Main Authors: Koscielny, Juergen, Ziemer, Sabine, Radtke, Hartmut, Schmutzler, Michael, Pruss, Axel, Sinha, Pranav, Salama, Abdulgabar, Kiesewetter, Holger, Latza, Reinhard
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antigens - analysis; Blood Coagulation - drug effects; Blood Coagulation Disorders - blood; Blood Coagulation Disorders - diagnosis; Blood Coagulation Disorders - epidemiology; Blood Coagulation Disorders - genetics; Blood Coagulation Tests; Collagen; Collagen - pharmacology; Elective Surgical Procedures; Epinephrine - pharmacology; Female; Fibrinogen; Humans; Male; Mass Screening; Medical Records; Middle Aged; Partial Thromboplastin Time; Platelet Activation - drug effects; Platelet Function Tests - instrumentation; Predictive Value of Tests; Preoperative Care - methods; Prevalence; Prospective Studies; Questionnaires; ROC Curve; Sensitivity and Specificity; Surveys and Questionnaires; Thrombophilia - blood; Thrombophilia - diagnosis; Thrombophilia - epidemiology; von Willebrand Factor - immunology
• ISSN: 1076-0296; 1938-2723
• DOI: 10.1177/107602960401000301

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.