Preoperative Bleeding Disorders

Abstract

The purpose of pre-operative screening for bleeding disorders is to eliminate clinically significant coagulopathy in the perioperative period. Goals include; identifying (and correcting) congenital and acquired defects in platelet function, the coagulation cascade, and fibrinolysis, as well as preparing for surgical procedures which in themselves pose a hemostatic risk. Undiagnosed coagulopathy may have legal implications while a broad, “shot-gun” use of serum coagulation tests for screening has unacceptable cost. The single most accurate and cheapest pre-operative screening method for bleeding disorders is the history and physical examination which, if combined with knowledge of the extent of the operation, can limit laboratory screening to only those patients at high risk of bleeding.