The British Committee for Standards in Haematology published guidance for preoperative assessment of bleeding risk. In general coagulation screening tests are poor predictors of postoperative bleeding in unselected patients.
The guidelines recommend a bleeding history that includes:
(1) family history of excessive bleeding
(2) personal history of excessive bleeding after trauma or surgery
(3) use of anti-thrombotic drugs
The patient should also be evaluated for comorbid conditions known to affect bleeding (liver disease, thrombocytopenia, etc).
If all of these items are negative, then no further testing is required.
If one or more risk factors is present, then testing should be individualized for the patient rather than using a standard protocol for all patients..
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