A Concept for Preoperative Identification of Patients with Impaired Primary Hemostasis

Abstract number: P1453

Koscielny J, Kalus U, Ziemer S, Radtke H, Sinha P, Salama A, Kiesewetter H

We present the findings of a large prospective study designed to identify primary and/or secondary hemostatic disorders prior to surgical interventions. Total of 5649 unselected adult patients were enrolled to identify impaired hemostasis prior to surgical interventions. Each patient was asked to answer a standardized questionnaire of bleeding history. Activated partial thromboplastin time (aPTT), prothrombin time (PT) and platelet counts (PC) including PFA-100 (platelet function analyser): collagen-epinephrine (C/E) and collagen-ADP (C/ADP) were routinely done in all patients. Additional tests, bleeding time (BT) and von Willebrand factor (vWF:Ag) were performed only in patients with a positive bleeding history and/or evidence of impaired hemostasis, e.g. drug ingestion. The bleeding history was negative in 5021 patients (88.8%) but positive in the remaining 628 (11.2%). Impaired hemostasis could be verified only in 256 (40.8%) of these patients. The vast majority were identified by PFA-100: C/E (n= 250; 97.7%). The vast majority were identified by PFA-100: C/E (n= 250; 97.7%). The other 6 patients with impaired hemostasis were identifiable solely based on the PT (n= 2), PFA-100: C/ADP (n= 2) and vWF:Ag (n= 2). The PFA-100: C/ADP detected 199 patients (77.7%). The only abnormality found among patients with a negative bleeding history was a prolonged aPTT due to lupus anticoagulant in 9 patients (0.2%). The sensitivity of the PFA-100: collagen-epinephrine was the highest (90.8%) in comparison to the other screening tests (BT, aPTT, PT, vWF:Ag). The positive predictive value of the PFA-100: collagen-epinephrine was high (81.8%), but the negative predictive value was higher (93.4%). The use of a standardized questionnaire and, if indicated, the PFA-100: C/E and/or other specific tests not only ensure the detection of impaired hemostasis in almost every case but also a significant reduction of the cost.