Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Preoperative assessment of hemostasis

Steven Coutre, MD
Section Editor
Lawrence LK Leung, MD
Deputy Editor
Jennifer S Tirnauer, MD


Perhaps one of the most important tasks that fall to the consultative hematologist is the preoperative assessment of hemostasis. The time-honored tools available to the hematologist include the clinical bleeding history, the physical examination, and a few select laboratory tests. Despite advances in clinical laboratory medicine and the advent of entirely new technologies, little has changed in the tests that are utilized for the assessment of bleeding risk. They remain remarkably effective in providing the information needed to evaluate the risk of bleeding in the surgical setting. The challenge remains to make sure that all patients at risk receive the proper evaluation so that bleeding complications are avoided.

This topic review will discuss the general approach to the preoperative assessment of hemostasis. Guidance concerning specific problem areas is provided separately, including the following:

Preoperative medical evaluation of the healthy patient. (See "Preoperative medical evaluation of the adult healthy patient".)

Surgical risk in patients with liver disease. (See "Assessing surgical risk in patients with liver disease".)

Performance of gastroenterologic procedures in patients with abnormal hemostasis. (See "Endoscopic procedures in patients with disorders of hemostasis".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Apr 21, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Rapaport SI. Preoperative hemostatic evaluation: which tests, if any? Blood 1983; 61:229.
  2. Wahlberg T, Blombäck M, Hall P, Axelsson G. Application of indicators, predictors and diagnostic indices in coagulation disorders. I. Evaluation of a self-administered questionnaire with binary questions. Methods Inf Med 1980; 19:194.
  3. Laine C, Williams SV, Wilson JF. In the clinic. Preoperative evaluation. Ann Intern Med 2009; 151:ITC1.
  4. De Paepe A, Malfait F. Bleeding and bruising in patients with Ehlers-Danlos syndrome and other collagen vascular disorders. Br J Haematol 2004; 127:491.
  5. Silver D. What Routine Preoperative Tests for Bleeding Tendencies? JAMA 1976; 236:2547.
  6. Eisenberg JM, Clarke JR, Sussman SA. Prothrombin and partial thromboplastin times as preoperative screening tests. Arch Surg 1982; 117:48.
  7. Kaplan EB, Sheiner LB, Boeckmann AJ, et al. The usefulness of preoperative laboratory screening. JAMA 1985; 253:3576.
  8. 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; 45:1413.
  9. Chee YL, Crawford JC, Watson HG, Greaves M. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Committee for Standards in Haematology. Br J Haematol 2008; 140:496.
  10. Velanovich V. The value of routine preoperative laboratory testing in predicting postoperative complications: a multivariate analysis. Surgery 1991; 109:236.
  11. Narr BJ, Warner ME, Schroeder DR, Warner MA. Outcomes of patients with no laboratory assessment before anesthesia and a surgical procedure. Mayo Clin Proc 1997; 72:505.
  12. Velanovich V. Preoperative laboratory screening based on age, gender, and concomitant medical diseases. Surgery 1994; 115:56.
  13. Wattsman TA, Davies RS. The utility of preoperative laboratory testing in general surgery patients for outpatient procedures. Am Surg 1997; 63:81.
  14. Adams JG Jr, Weigelt JA, Poulos E. Usefulness of preoperative laboratory assessment of patients undergoing elective herniorrhaphy. Arch Surg 1992; 127:801.
  15. Danielson D, Bjork K, Card R, et al. Institute for Clinical Systems Improvement. Preoperative Evaluation. Available at: http://www.icsi.org/preoperative_evaluation/preoperative_evaluation_2328.html (Accessed on August 30, 2012).
  16. 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:e6.
  17. Macpherson CR, Jacobs P, Dent DM. Abnormal peri-operative haemorrhage in asymptomatic patients is not predicted by laboratory testing. S Afr Med J 1993; 83:106.
  18. 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; 170:19.
  19. Blery C, Charpak Y, Szatan M, et al. Evaluation of a protocol for selective ordering of preoperative tests. Lancet 1986; 1:139.
  20. Rohrer MJ, Michelotti MC, Nahrwold DL. A prospective evaluation of the efficacy of preoperative coagulation testing. Ann Surg 1988; 208:554.
  21. Munro J, Booth A, Nicholl J. Routine preoperative testing: a systematic review of the evidence. Health Technol Assess 1997; 1:i.
  22. Wojtkowski TA, Rutledge JC, Matthews DC. The clinical impact of increased sensitivity PT and APTT coagulation assays. Am J Clin Pathol 1999; 112:225.
  23. Lind SE. The bleeding time does not predict surgical bleeding. Blood 1991; 77:2547.
  24. Gewirtz AS, Miller ML, Keys TF. The clinical usefulness of the preoperative bleeding time. Arch Pathol Lab Med 1996; 120:353.
  25. Gravlee GP, Arora S, Lavender SW, et al. Predictive value of blood clotting tests in cardiac surgical patients. Ann Thorac Surg 1994; 58:216.
  26. Burk CD, Miller L, Handler SD, Cohen AR. Preoperative history and coagulation screening in children undergoing tonsillectomy. Pediatrics 1992; 89:691.
  27. Close HL, Kryzer TC, Nowlin JH, Alving BM. Hemostatic assessment of patients before tonsillectomy: a prospective study. Otolaryngol Head Neck Surg 1994; 111:733.
  28. Myers ER, Clarke-Pearson DL, Olt GJ, et al. Preoperative coagulation testing on a gynecologic oncology service. Obstet Gynecol 1994; 83:438.
  29. Rader ES. Hematologic screening tests in patients with operative prostatic disease. Urology 1978; 11:243.