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Stratifying a Patient’s Preoperative Risk for Bleeding

In the current climate of antiplatelet and antithrombotic drug use, determining risk for perioperative bleeding is especially important; however, it sometimes may be difficult to measure the preoperative effect of certain agents such as clopidogrel.

The following coagulopathy tests are routinely done, but how much predictive value do they have for bleeding risk?
  • ACT (activated clotting time)
  • aPTT (activated partial thrombin time)
  • PT (prothrombin time)
  • TT (thrombin time)

According to vascular surgeon Jeffrey H. Lawson, most hemostatic tests have variable importance: a test that may be valid preoperatively may not have validity postoperatively. In his view, the only effective predictor of risk for bleeding is patient history of bleeding.


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