A PROSPECTIVE MULTICENTER EVALUATION OF PREOPERATIVE HEMOSTATIC SCREENING-TESTS

BACKGROUND: Several retrospective and four prospective reports have qu estioned the need for routine preoperative hemostatic screening tests (PHST) in general surgery. PATIENTS AND METHODS: The results of four s tandard tests (prothrombin time, activated partial thromboplastin time , platelet count, and bleeding time) were prospectively compared with patient history and clinical data in a multicenter study of 3,242 cons ecutive patients, The patients were divided into four groups: group A (n = 1,951) had no clinical or PHST abnormalities; group B (n = 340) h ad no clinical and one or more PHST abnormalities; group C (n = 779) h ad one or more clinical and no PHST abnormalities; group D (n = 172) h ad both clinical and PHST abnormalities, RESULTS: Preoperative modific ations of guidelines (postponed operations and ordering of additional hemostatic tests) were significantly more frequent in both groups of p atients with PHST abnormalities (groups B and D), but specific treatme nt to correct hemostatic disorders was prescribed only when clinical a bnormalities were also present (group D). Intraoperatively, modificati ons of anesthetic and surgical vigilance (planning of increased number of blood units, vascular catheter placement, and number of patients r equiring transfusion) were significantly more frequent in group D. Pos toperatively, all groups had similar incidences of hematoma or bruises , volumes of blood loss per drainage, reoperations to control hemorrha ge, and mortality due to bleeding (n = 5), CONCLUSIONS: Our results su ggest that PHST should not be performed routinely, but only in patient s with abnormal clinical data, Such a policy necessitates a thorough h istory-including answers to a specific questionnaire like those used i n prospective studies-and a rigorous, well-conducted physical examinat ion.