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Preoperative clinical assessment of hemostatic function in patients scheduled for a cardiac operation
1Department of Anesthesia, University Hospital, Geneva, Switzerland.
Insights
Preoperative assessment of bleeding risk in cardiac surgery patients is effective. A thorough patient interview and physical exam can identify those needing transfusions, enabling early blood conservation strategies.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Anesthesiology
Background:
- Bleeding post-cardiac surgery often stems from surgical hemostasis issues or cardiopulmonary bypass complications.
- Patient-specific factors contributing to bleeding are frequently overlooked in preoperative assessments.
Purpose of the Study:
- To review clinical elements predicting increased perioperative blood needs in surgical patients.
- To identify key factors for preoperative assessment of bleeding risk in cardiac surgery.
Main Methods:
- Review of articles published between 1976 and 1996 concerning preoperative patient assessment.
- Focus on identifying clinical elements predictive of elevated perioperative blood requirements.
Main Results:
- Preoperative assessment involves a detailed patient interview (history of bruising, bleeding, drug use) and physical examination.
- A standardized questionnaire improves assessment reliability for identifying high-risk patients.
- Early identification allows enrollment in programs to reduce bleeding and allogeneic blood transfusions.
Conclusions:
- Clinical assessment of hemostatic function before cardiac operations is effective and efficient.
- Routine laboratory testing for hemostasis can be avoided.
- Facilitates early implementation of blood conservation strategies in patient care.
Background:
Bleeding during and after cardiac operations is usually attributed to inadequate surgical hemostasis or cardiopulmonary bypass-induced disorders of hemostasis. Patient-related factors often are neglected.
Methods:
Articles published between 1976 and 1996 on the preoperative assessment of surgical patients were reviewed to determine the clinical elements most likely to predict increased perioperative blood requirements.
Results:
Preoperative assessment is based on a carefully conducted interview (history of bruising, petechiae, recent or excessive bleeding after operation, chronic drug therapy) and physical examination. A standardized questionnaire to enhance the reliability of the assessment is presented. Thus, patients at high risk of being transfused can be identified early on and may be enrolled in various programs designed to decrease bleeding and the need for allogeneic blood transfusions.
Conclusions:
Clinical assessment of hemostatic function before cardiac operations is both effective and efficient. It obviates the need for routine laboratory testing and favors the introduction of blood conservation strategies early on during the process of care.