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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Screening for the risk for bleeding or thrombosis
Mark H Eckman1, John K Erban, Sushil K Singh
1Division of General Internal Medicine, University of Cincinnati Medical Center, PO Box 670535, 231 Albert Sabin Way, Cincinnati, OH 45267-0535, USA.
Annals of Internal Medicine
|February 1, 2003
Summary
Routine coagulation testing offers no benefit for assessing bleeding risk in most nonsurgical and surgical patients. It is also not recommended after a first venous thromboembolic event for most individuals.
Area of Science:
- Clinical Pathology
- Hematology
- Diagnostic Testing
Background:
- Numerous diagnostic tests exist to evaluate patient bleeding or thrombosis risk.
- Test selection requires careful consideration of clinical context, disease prevalence, test performance, cost, and potential misdiagnosis outcomes.
Purpose of the Study:
- To review coagulation testing information in three key clinical scenarios.
- Settings include: nonsurgical hospitalized patients, surgical patients, and individuals experiencing a first venous thromboembolic event.
Main Methods:
- Systematic literature search of MEDLINE (1966-2002) and reference lists.
- Included studies on routine coagulation testing, preoperative testing, and factor V Leiden mutation with thromboembolic outcomes.
- Extracted data from 5 observational studies (nonsurgical) and 12 (preoperative) for sensitivity and specificity analysis.
Main Results:
- Partial thromboplastin time (PTT) performance for predicting postoperative hemorrhage was analyzed by surgery type.
- Prolonged PTT did not significantly increase the risk of postoperative complications.
- Likelihood ratios and confidence intervals were calculated for test results.
Conclusions:
- Routine coagulation testing is not beneficial for assessing bleeding risk in nonsurgical and surgical patients without liver dysfunction or oral anticoagulant use.
- Routine testing is generally not recommended following a first venous thromboembolic event.
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