Prothrombin and partial thromboplastin times as preoperative screening tests

Preoperative tests of coagulation function have been suggested to detect patients who are likely to have abnormal bleeding during and after surgery. A study was designed to determine the yield of prothrombin time (PT) and partial thromboplastin time (PTT), both in discovering patients who are at risk for abnormal bleeding and in inducing changes in patient care or outcome. Of 750 patients on three surgical services, 611 (81%) patients had no indication of a bleeding disorder on history or physical examination. Of the 139 patients who had clinical indications, 25 (18.0%) patients had an abnormal PT or PTT. Of the 611 patients without clinical indications, 480 patients had the PT or PTT determined, and 13 (2.7%) patients had abnormal results. One (0.2%) of the 480 patients might have benefited from the test result (this patient required a second operation to control arterial bleeding). The prolonged PT or PTT was of no apparent clinical importance in the remaining 12 patients without indications of bleeding disorders preoperatively. The low yield of the PT and PTT in detecting unsuspected bleeding disorders preoperatively was further obscured by the larger number of apparently false-positive results.