Haemostatic testing prior to elective surgery in children? Not always!

Area of Science:

• Anesthesiology
• Hematology
• Preoperative Medicine

Background:

• Preoperative coagulation tests are widely used in Germany to assess bleeding risk.
• This practice is based on the assumption that these tests can identify at-risk patients.
• However, current evidence challenges the efficacy of both traditional and novel coagulation screening tests.

Purpose of the Study:

• To evaluate the effectiveness of preoperative coagulation tests in identifying patients with increased bleeding risk.
• To highlight the limitations of unselected laboratory screening in preoperative settings.
• To advocate for evidence-based approaches in preoperative bleeding risk assessment.

Main Methods:

• Review of published evidence on the utility of preoperative coagulation tests.
• Analysis of the diagnostic yield and limitations of screening tests and global haemostasis assessment.
• Evaluation of the role of patient bleeding history and standardized questionnaires.

Main Results:

• Unselected preoperative coagulation screening leads to numerous false positives and identifies irrelevant disorders.
• This approach can cause surgical delays, patient anxiety, and is not cost-effective.
• Screening tests fail to reliably detect significant bleeding disorders like von Willebrand disease.

Conclusions:

• A detailed bleeding history, including family history, is a more effective tool for identifying patients at risk.
• International guidelines recommend mandatory standardized questionnaires for preoperative screening.
• A diagnostic pathway should guide the use of specific tests, and guidelines for managing unexpected bleeding are necessary.