Abstract
Recognizing the complexity of coagulation tests and currently used anticoagulants, we developed this illustrated review on bleeding assessment tools and common coagulation screening tests. Quantitative bleeding assessment tools (BATs) are available to standardize the bleeding history and improve the pretest probability prior to coagulation testing. We describe use of BATs and the principles, indications, and limitations of the prothrombin time (PT)/International Normalized Ratio, activated partial thromboplastin time (APTT), and 50:50 mix. Use of these tests to identify coagulation factor deficiencies, specific and nonspecific inhibitors, coagulopathy of liver disease, disseminated intravascular coagulation, and commonly used anticoagulant medications are reviewed. Current literature suggests that unnecessary coagulation testing is rampant. The PT and APTT have astoundingly low sensitivity (1.0%‐2.1%) for detection of clinically significant bleeding disorders. Thus, current guidelines recommend against the use of screening PT and APTT in preoperative patients undergoing noncardiac/vascular surgery.
Keywords: bleeding disorders, clinical laboratory techniques, hemorrhage, International Normalized Ratio, thrombosis
Essentials.
Quantitative bleeding assessment tools standardize the bleeding history and improve the pretest probability of bleeding disorders prior to coagulation testing.
Unnecessary coagulation testing is rampant.
Thorough understanding of common hemostatic tests is essential for appropriate selection and interpretation of tests.
RELATIONSHIP DISCLOSURE
The authors declare no conflicts of interest.
AUTHOR CONTRIBUTIONS
CE and MS developed the concepts and images, wrote the manuscript, and approved the final content.
Elbaz C, Sholzberg M. An illustrated review of bleeding assessment tools and common coagulation tests. Res Pract Thromb Haemost. 2020;4:761–773. 10.1002/rth2.12339
Handling Editor: Pantep Angchaisuksiri
Contributor Information
Carolyne Elbaz, Email: carolyne.elbaz@mail.mcgill.ca, @ElbCarolyne.
Michelle Sholzberg, @sholzberg.
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