A Practical Concept for Preoperative Identification of Patients with Impaired Primary Hemostasis
| Autor: | Axel Pruss, H. Radtke, J. Koscielny, Abdulgabar Salama, H. Kiesewetter, R. Latza, Sabine Ziemer, Michael Schmutzler, Pranav Sinha |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Male
030204 cardiovascular system & hematology Gastroenterology Medical Records 0302 clinical medicine Surveys and Questionnaires Prevalence Coagulation testing Mass Screening Thrombophilia Prospective Studies 030212 general & internal medicine Aged 80 and over Lupus anticoagulant medicine.diagnostic_test Hematology General Medicine Blood Coagulation Disorders Middle Aged Elective Surgical Procedures Female Partial Thromboplastin Time Blood Coagulation Tests Collagen Partial thromboplastin time Adult medicine.medical_specialty Adolescent Epinephrine Platelet Function Tests Sensitivity and Specificity 03 medical and health sciences Predictive Value of Tests Bleeding time Internal medicine Preoperative Care von Willebrand Factor medicine Humans Antigens Blood Coagulation Mass screening Aged Prothrombin time business.industry PFA-100 Fibrinogen Platelet Activation medicine.disease Surgery ROC Curve Hemostasis business |
| Zdroj: | Clinical and Applied Thrombosis/Hemostasis. 10:195-204 |
| ISSN: | 1938-2723 1076-0296 |
| DOI: | 10.1177/107602960401000301 |
| Popis: | The findings of a large prospective study designed to identify primary and/or secondary hemostatic disorders before surgical interventions are presented. A total of 5649 unselected adult patients were enrolled to identify impaired hemostasis before surgical interventions. Each patient was asked to answer a standardized questionnaire concerning bleeding history. Activated partial thromboplastin time (aPTT), prothrombin time (PT), and platelet counts (PC) including PFA-100 (platelet function analyzer): 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 with PFA-100: C/E (n=250; 97.7%). The other six 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 nine 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|