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Semin Thromb Hemost 2008; 34(1): 097-103
DOI: 10.1055/s-2008-1066028
© Thieme Medical Publishers

Can We Predict Bleeding?

Henry G. Watson1 , Mike Greaves1
  • 1Aberdeen Royal Infirmary and University of Aberdeen, Aberdeen, Scotland
Further Information

Publication History

Publication Date:
07 April 2008 (online)

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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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 3 Lind S E. The bleeding time does not predict surgical bleeding.  Blood. 1991;  77 2547-2552
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 7 Luddington R J. Thrombelastography.  Clin Lab Haematol. 2005;  27 81-90
    CrossrefPubMedGoogle Scholar
  • 8 Salooja N, Perry D J. Thrombelastography.  Blood Coagul Fibrinolysis. 2001;  12 327-337
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 15 Watson H G. Thromboelastography should be available in every labour ward.  Int J Obstet Anesth. 2005;  14 325-327
    CrossrefPubMedGoogle Scholar
  • 16 Macfarlane R G, Biggs R. A thrombin generation test; the application in haemophilia and thrombocytopenia.  J Clin Pathol. 1953;  6 3-8
    CrossrefPubMedGoogle Scholar
  • 17 Hemker H C, Beguin S. Thrombin generation in plasma: its assessment via the endogenous thrombin potential.  Thromb Haemost. 1995;  74 134-138
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 43 Hayward C P. Diagnosis and management of mild bleeding disorders.  Hematology Am Soc Hematol Educ Program. 2005;  423-428
    PubMedGoogle Scholar
  • 44 Suchman A L, Mushlin A I. How well does the activated partial thromboplastin time predict postoperative hemorrhage?.  JAMA. 1986;  256 750-753
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

Dr. Henry G Watson

Aberdeen Royal Infirmary and University of Aberdeen

Aberdeen, Scotland

Email: Henry.Watson@arh.grampian.scot.nhs.uk