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Related Experiment Videos

Predicting hemorrhage using preoperative coagulation screening assays.

Walter H Dzik1

  • 1Blood Transfusion Service, J-224, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. sdzik@partners.org

Current Hematology Reports
|September 3, 2004
PubMed
Summary

Millions of blood products are transfused annually to non-bleeding patients before procedures. This review questions if common lab tests accurately predict bleeding risk, suggesting more research is needed.

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Area of Science:

  • Transfusion Medicine
  • Clinical Pathology
  • Evidence-Based Medicine

Background:

  • Fresh frozen plasma and platelet transfusions are common in the US, with millions of units used yearly.
  • A significant number of transfusions are given prophylactically to non-bleeding patients before invasive procedures.
  • Decisions for these transfusions are often based on abnormal laboratory hemostasis tests like prothrombin time (PT) or platelet counts.

Purpose of the Study:

  • To review existing literature on the predictive value of mild to moderate hemostasis test abnormalities for bleeding risk during invasive bedside procedures.
  • To evaluate if current laboratory triggers for prophylactic transfusions are clinically justified.

Main Methods:

  • Systematic review of published studies.

Related Experiment Videos

  • Analysis of data correlating laboratory hemostasis test results with bleeding outcomes in patients undergoing various invasive procedures.
  • Evaluation of the predictive performance of PT (INR) and platelet counts.

    • Main Results:

    • The review found that mild to moderate abnormalities in common hemostasis tests have poor predictive value for bleeding risk.
    • The prothrombin time (PT) international normalized ratio (INR) assay's design contributes to its poor predictive performance.
    • Evidence supporting the use of these tests as triggers for prophylactic transfusions is limited.

    Conclusions:

    • Mild to moderate abnormalities in PT (INR) and platelet counts may not reliably indicate an increased risk of bleeding during invasive procedures.
    • The clinical utility of using common laboratory hemostasis tests to guide prophylactic transfusions requires further investigation.
    • Randomized clinical trials are needed to determine the true predictive value of these tests and establish appropriate transfusion guidelines.