Consensus document on ordering preoperative coagulation tests

Standard pre-operative coagulation tests are insensitive to certain haemostatic abnormalities, yet they continue to be ordered routinely. Given the lack of clear guidance in Spain, we used Delphi methodology to develop a series of consensus recommendations on ordering these tests.

We conducted a 3-round, online, multicentre Delphi study in which 10 expert anaesthesiologists were asked to recruit colleagues to form a panel of 59 anaesthesiologists, 50 of which completed all rounds. The panel rated 46 statements on a 1-9 Likert scale. Consensus was achieved when ≥70% of questions scored ≥7 in the third round. Accepted statements were classified as Weak (70%-79%), Moderate (80%-89%) or Strong (90%-100%) agreement.

Twenty-nine statements were accepted. These were synthesized into 21 statements that were grouped into 6 categories: general indication, patient risk factors, procedure characteristics, global assessment, paediatric patients, and special cases. Agreement was strong for 14 statements, moderate for 5, and weak for 2. Key recommendations were: (1) avoid universal testing; (2) base testing on medical history, standard bleeding-risk questionnaires, and specific risk factors (anticoagulation, liver disease, kidney failure, haematopoietic disorders); (3) order tests before high-complexity or high-bleeding-risk procedures; and (4) use specific tests in patients receiving direct oral anticoagulants.

Pre-operative coagulation testing is indicated in patients that present bleeding disorders and/or are scheduled for a high-bleeding-risk procedure.