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The clinical usefulness of the preoperative bleeding time
A S Gewirtz1, M L Miller, T F Keys
1Department of Clinical Pathology, The Cleveland Clinic Foundation, Ohio 44195, USA.
Objectives:
To determine the clinical utilization of the Simplate bleeding time test as a preoperative screen, to examine the clinical utilization of the bleeding time test by multiple surgical services, and to correlate the indicators of bleeding risk (bleeding history, thrombocytopenia, prolonged prothrombin time/activated partial thromboplastin time, increased creatinine, and medications known to interfere with platelet function) with the bleeding time and the occurrence of clinically significant perioperative bleeding.
Design:
Retrospective data analysis.
Setting:
A large tertiary-care hospital.
Patients:
One hundred sixty-seven consecutive surgical patients tested for preoperative bleeding time.
Main Outcome Measures:
The occurrence of clinically significant perioperative bleeding and the positive and negative predictive value of the preoperative screening bleeding time test.
Results:
Patients with a positive bleeding history were more likely to have an abnormal bleeding time (P = .04), but there was no statistically significant association between patients with an abnormal bleeding time and the other indicators of bleeding risk examined or the occurrence of clinically significant perioperative bleeding. The positive predictive value of the preoperative bleeding time was 5%, and the negative predictive value was 95%.
Conclusions:
Screening for preoperative bleeding time is not a reliable test for assessing the risk of clinically significant perioperative bleeding and should not be used for this purpose.