Hemostatic evaluation before abdominal interventions: an overview and proposal.

Publisher Website
Google Scholar
Abstract
Despite many years of routine interventional practice, no specific guidelines exist on how to evaluate a patient's he- mostatic function before a procedure. In many institutions, patients are often tested for prothrombin time (PT), partial thromboplastin time (PTT), and platelet count with little regard for the type of procedure planned or the patient's history. Clearly, not all patients need to undergo these tests routinely. In a complex climate of increasing litigation and rising health- care costs, how can we best identify the unsuspected bleeder or evaluate the suspected bleeder? No published radiologic studies have specifically examined these questions. A prospective randomized investigation of a large number of patients needs to be performed, whereby numerous factors including patient's history, procedure per- formed, techniques used, and laboratory tests all would be examined and compared with specific outcomes. Using nonvascular abdominal interventions as a model, we propose specific guidelines on how to evaluate a patient's hemostatic function before an interventional procedure. The recommendations are based on Rapaport's preoperative as- sessment of 1983 (1) and modified for interventional radiol- ogy. The basic idea is that the extent of the laboratory evaluation is determined by the patient's medical history and the procedure planned. This allows minor procedures to be done in healthy patients without laboratory testing, and a thorough laboratory evaluation can be done both before in- vasive procedures and in patients whose history suggests a bleeding disorder. We hope these guidelines will someday serve as a template for prospective study or at least provide

This publication has 0 references indexed in Scilit: