Are routine preoperative hemostatic screening tests necessary in Japanese institutions?
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LETTER TO THE EDITOR
Are routine preoperative hemostatic screening tests necessary in Japanese institutions? Koichi Takita • Yumiko Yamazaki Yuji Morimoto
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Received: 31 August 2012 / Accepted: 18 November 2012 / Published online: 2 December 2012 Ó Japanese Society of Anesthesiologists 2012
Keywords Elective surgery Coagulation screening Unselected patients Abnormal bleeding
To the Editor: Western guidelines do not recommend preoperative hemostatic screening tests in unselected patients for predicting the risk of hemorrhagic complications, though the evidence that these tests do not help avoid neurological complications associated with neuraxial blockade is scant [1, 2]. However, the clinical significance of these tests has not been evaluated in Japan. After internal review board (IRB) approval, we retrospectively examined the incidences of unexpected abnormal results of routine screening tests of the prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), and platelet count at Hokkaido University Hospital and whether unexpected abnormal results were associated with perioperative hemorrhagic complications. Results of the routine hemostatic screening tests from patients scheduled for elective surgery other than cardiac surgery, thoracic aortic surgery, liver transplantation, and surgery with local anesthesia between 1 January 2010 and 31 December 2011 and their medical records were reviewed. There are specific abnormality criteria for which invasive procedures are not considered safe: platelet count \100,000/ll; PT/INR C1.5; aPTT C50 s (upper limit of normal ranges for aPTT in our institution is 41.5 s) [3, 4]. During the 2-year study period, 7,180 patients were scheduled for elective surgery.
K. Takita (&) Y. Yamazaki Y. Morimoto Department of Anesthesiology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan e-mail: [email protected]
Preoperative screening tests of coagulation and platelet counts were done in 6,727 and 7,055 patients, respectively, at our hospital. The incidences of abnormal PT/INR, aPTT and thrombocytopenia were 0.62 % [95 % confidential interval (CI) calculated using the exact Clopper–Pearson method 0.45–0.84), 2.13 % (95 % CI 1.79–2.50), and 1.37 % (95 % CI 1.12–1.67), respectively. There was only one case in which the operation was cancelled due to an abnormal hemostatic test. The patient had thrombocytopenia associated with known liver cirrhosis and had been scheduled for a lumbar spine fusion operation. The incidences of patients with prolonged PT/INR, aPTT, and thrombocytopenia without already-known risk factors accounting for abnormal tests, such as anticoagulant therapy, blood disease, and liver disease, were 0.00 % (95 % CI 0.00–0.05), 0.24 % (95 % CI 0.11–0.35), and 0.20 % (95 % CI 0.11–0.33), respectively. In one patient, an unexpected thrombocytopenia was diagnosed as pseudothrombocytopenia by further examination. The remaining 27 patients with unexpected abnormal aP
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