RSS-Feed abonnieren
DOI: 10.1055/s-2008-1066028
Can We Predict Bleeding?
Publikationsverlauf
Publikationsdatum:
07. April 2008 (online)
![](https://www.thieme-connect.de/media/sth/200801/lookinside/thumbnails/10.1055-s-2008-1066028-1.jpg)
ABSTRACT
The prior identification of subjects who are likely to bleed excessively when subjected to operative surgery and other invasive procedures is desirable. Frequently, reliance is placed on laboratory-based screening tests of blood coagulation for this purpose. However, published evidence does not support this approach as the tests are not fit for purpose, and their sensitivity and specificity are low. Some more global assays may have use in the diagnostic workup in subjects with hemorrhage, but none has been established to date as an efficient method for prediction of bleeding in unselected populations. There is renewed interest in the use of the clinical history for the prediction of bleeding. Recent reports suggest that when a structured questionnaire is employed to derive a bleeding score, the positive predictive value of the approach for the detection of bleeding disorders is high.
KEYWORDS
Bleeding - preoperative screening - coagulation tests - global coagulation assays
REFERENCES
- 1 Chee Y L, Greaves M. Role of coagulation testing in predicting bleeding risk. Hematol J. 2003; 4 373-378
- 2 Chee Y L, Crawford J C, Watson H G, Greaves M. Guidelines on the assessment of bleeding risk prior to surgery and invasive procedures. Available at: http://www.bcshguidelines.com/pdf/Coagscreen200107.pdf Accessed March 20, 2008
- 3 Lind S E. The bleeding time does not predict surgical bleeding. Blood. 1991; 77 2547-2552
- 4 O'Laughlin J C, Hoftiezer J W, Mahoney J P, Ivey K J. Does aspirin prolong bleeding from gastric biopsies in man?. Gastrointest Endosc. 1981; 27 1-5
- 5 Jalan R, Grose R, Dillon J F, Simpson K, Hayes P C. Gastric mucosal bleeding time in cirrhosis. Gastrointest Endosc. 1994; 40 599-602
- 6 McNicol P L, Liu G, Harley I D et al.. Patterns of coagulopathy during liver transplantation: experience with the first 75 cases using thrombelastography. Anaesth Intensive Care. 1994; 22 659-665
- 7 Luddington R J. Thrombelastography. Clin Lab Haematol. 2005; 27 81-90
- 8 Salooja N, Perry D J. Thrombelastography. Blood Coagul Fibrinolysis. 2001; 12 327-337
- 9 Spiess B D, Gillies B S, Chandler W, Verrier E. Changes in transfusion therapy and reexploration rate after institution of a blood management program in cardiac surgical patients. J Cardiothorac Vasc Anesth. 1995; 9 168-173
- 10 Shore-Lesserson L, Manspeizer H E, DePerio M, Francis S, Vela-Cantos F, Ergin M A. Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery. Anesth Analg. 1999; 88 312-319
- 11 Anderson L, Quasim I, Soutar R, Steven M, Macfie A, Korte W. An audit of red cell and blood product use after the institution of thromboelastometry in a cardiac intensive care unit. Transfus Med. 2006; 16 31-39
- 12 Avidan M S, Alcock E L, Da Fonseca J et al.. Comparison of structured use of routine laboratory tests or near-patient assessment with clinical judgement in the management of bleeding after cardiac surgery. Br J Anaesth. 2004; 92 178-186
- 13 Kaufmann C R, Dwyer K M, Crews J D, Dols S J, Trask A L. Usefulness of thrombelastography in assessment of trauma patient coagulation. J Trauma. 1997; 42 716-722
- 14 Rugeri L, Levrat A, David J S et al.. Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography. J Thromb Haemost. 2007; 5 289-291
- 15 Watson H G. Thromboelastography should be available in every labour ward. Int J Obstet Anesth. 2005; 14 325-327
- 16 Macfarlane R G, Biggs R. A thrombin generation test; the application in haemophilia and thrombocytopenia. J Clin Pathol. 1953; 6 3-8
- 17 Hemker H C, Beguin S. Thrombin generation in plasma: its assessment via the endogenous thrombin potential. Thromb Haemost. 1995; 74 134-138
- 18 Rand M D, Lock J B, van't Veer C, Gaffney D P, Mann K G. Blood clotting in minimally altered whole blood. Blood. 1996; 88 3432-3445
- 19 Hemker H C, Giesen P, AlDieri R et al.. The calibrated automated thrombogram (CAT): a universal routine test for hyper- and hypocoagulability. Pathophysiol Haemost Thromb. 2002; 32 249-253
- 20 Al Dieri R, Peyvandi F, Santagostino E et al.. The thrombogram in rare inherited coagulation disorders: its relation to clinical bleeding. Thromb Haemost. 2002; 88 576-582
- 21 Beltran-Miranda C P, Khan A, Jaloma-Cruz A R, Laffan M A. Thrombin generation and phenotypic correlation in haemophilia A. Haemophilia. 2005; 11 326-334
- 22 Fressinaud E, Veyradier A, Truchaud F et al.. Screening for von Willebrand disease with a new analyzer using high shear stress: a study of 60 cases. Blood. 1998; 91 1325-1331
- 23 Podda G M, Bucciarelli P, Lussana F, Lecchi A, Cattaneo M. Usefulness of PFA-100® testing in the diagnostic screening of patients with suspected abnormalities of hemostasis: comparison with the bleeding time. J Thromb Haemost. 2007; 5 2393-2398
- 24 Hayward C P, Harrison P, Cattaneo M, Ortel T L, Rao A K. The Platelet Physiology Subcommittee of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis . Platelet function analyzer (PFA)-100 closure time in the evaluation of platelet disorders and platelet function. J Thromb Haemost. 2006; 4 312-319
- 25 Reiter R A, Mayr F, Blazicek H et al.. Desmopressin antagonizes the in vitro platelet dysfunction induced by GPIIb. Blood. 2003; 102 4594-4599
- 26 Fressinaud E, Veyradier A, Sigaud M, Boyer-Neumann C, Le Boterff C, Meyer D. Therapeutic monitoring of von Willebrand disease: interest and limits of a platelet function analyser at high shear rates. Br J Haematol. 1999; 106 777-783
- 27 Cattaneo M, Lecchi A, Agati B, Lombardi R, Zighetti M L. Evaluation of platelet function with the PFA-100 system in patients with congenital defects of platelet secretion. Thromb Res. 1999; 96 213-217
- 28 Escolar G, Cases A, Vinas M et al.. Evaluation of acquired platelet dysfunctions in uremic and cirrhotic patients using the platelet function analyzer (PFA-100): influence of hematocrit elevation. Haematologica. 1999; 84 614-619
- 29 Andersen K, Hurlen M, Arnesen H, Seljeflot I. Aspirin non-responsiveness as measured by PFA-100 in patients with coronary artery disease. Thromb Res. 2002; 108 37-42
- 30 Alberts M J, Bergman D L, Molner E, Jovanovic B D, Ushiwata I, Teruya J. Antiplatelet effect of aspirin in patients with cerebrovascular disease. Stroke. 2004; 35 175-178
- 31 Derhaschnig U, Pachinger C, Jilma B. Variable inhibition of high-shear-induced platelet plug formation by eptifibatide and tirofiban under conditions of platelet activation and high von Willebrand release: a randomized, placebo-controlled, clinical trial. Br J Haematol. 2008; 140(5) 496-504
- 32 Koscielny J, Kiesewetter H, von Tempelhoff G F. More on: platelet function analyzer (PFA)-100 closure time in the evaluation of platelet disorders and platelet function. J Thromb Haemost. 2006; 4 1426-1434
- 33 Kratzer M A. Platelet function analyzer (PFA)-100 closure time in the evaluation of platelet disorders and platelet function: a rebuttal. J Thromb Haemost. 2006; 4 1845-1846
- 34 Harrison P, Segal H, Blasbery K, Furtado C, Silver L, Rothwell P M. Screening for aspirin responsiveness after transient ischemic attack and stroke: comparison of 2 point-of-care platelet function tests with optical aggregometry. Stroke. 2005; 36 1001-1005
- 35 Wang J C, Aucoin-Barry D, Manuelian D et al.. Incidence of aspirin nonresponsiveness using the Ultegra rapid platelet function assay-ASA. Am J Cardiol. 2003; 92 1492-1494
- 36 Wheeler G L, Braden G A, Steinhubl S R et al.. The Ultegra rapid platelet-function assay: comparison to standard platelet function assays in patients undergoing percutaneous coronary intervention with abciximab therapy. Am Heart J. 2002; 143 602-611
- 37 Kadir R A, Economides D L, Sabin C A, Owens D, Lee C A. Frequency of inherited bleeding disorders in women with menorrhagia. Lancet. 1998; 351 485-489
- 38 Edlund M, Blomback M, von Schoultz B, Andersson O. On the value of menorrhagia as a predictor for coagulation disorders. Am J Hematol. 1996; 53 234-238
- 39 Philipp C S, Miller C H, Faiz A et al.. Screening women with menorrhagia for underlying bleeding disorders: the utility of the platelet function analyser and bleeding time. Haemophilia. 2005; 11 497-503
- 40 Sramek A, Eikenboom J C, Briet E, Vandenbroucke J P, Rosendaal F R. Usefulness of patient interview in bleeding disorders. Arch Intern Med. 1995; 155 1409-1415
- 41 Rodeghiero F, Castaman G, Tosetto A et al.. The discriminant power of bleeding history for the diagnosis of type 1 von Willebrand disease: an international, multicenter study. J Thromb Haemost. 2005; 3 2619-2626
- 42 McKay H, Derome F, Haq M A et al.. Bleeding risks associated with inheritance of the Quebec platelet disorder. Blood. 2004; 104 159-165
- 43 Hayward C P. Diagnosis and management of mild bleeding disorders. Hematology Am Soc Hematol Educ Program. 2005; 423-428
- 44 Suchman A L, Mushlin A I. How well does the activated partial thromboplastin time predict postoperative hemorrhage?. JAMA. 1986; 256 750-753
- 45 Houry S, Georgeac C, Hay J M, Fingerhut A, Boudet M J. A prospective multicenter evaluation of preoperative hemostatic screening tests. The French Associations for Surgical Research. Am J Surg. 1995; 170 19-23
- 46 Howells II R C, Wax M K, Ramadan H H. Value of preoperative prothrombin time/partial thromboplastin time as a predictor of postoperative hemorrhage in pediatric patients undergoing tonsillectomy. Otolaryngol Head Neck Surg. 1997; 117 628-632
- 47 Gabriel P, Mazoit X, Ecoffey C. Relationship between clinical history, coagulation tests, and perioperative bleeding during tonsillectomies in pediatrics. J Clin Anesth. 2000; 12 288-291
- 48 Tosetto A, Rodeghiero F, Castaman G et al.. A quantitative analysis of bleeding symptoms in type 1 von Willebrand disease: results from a multicenter European study (MCMDM-1 VWD). J Thromb Haemost. 2006; 4 766-773
Dr. Henry G Watson
Aberdeen Royal Infirmary and University of Aberdeen
Aberdeen, Scotland
eMail: Henry.Watson@arh.grampian.scot.nhs.uk