Preoperative assessment of hemostasis
- Steven Coutre, MD
Steven Coutre, MD
- Professor of Medicine
- Stanford University Medical School
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".)
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- THE CLASSIC APPROACH
- The clinical history
- - Patient questionnaires
- The physical examination
- LABORATORY TESTING
- Coagulation testing and platelet count
- Bleeding time
- SPECIFIC SURGICAL PROCEDURES AND THEIR BLEEDING RISKS
- Coronary artery bypass surgery
- Gynecologic surgery
- Prostate surgery
- Routine screening
- Medical and hematologic consultations