0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Academia and the Profession |

Screening for the Risk for Bleeding or Thrombosis

Mark H. Eckman, MD; John K. Erban, MD; Sushil K. Singh, MD; and Grace S. Kao, MD
[+] Article and Author Information

From University of Cincinnati, Cincinnati, Ohio; and New England Medical Center, Boston, Massachusetts.


Grant Support: In part by grant LM 07092-08 from the National Library of Medicine, Bethesda, Maryland.

Potential Financial Conflicts of Interest: None disclosed.

Current Author Addresses: Dr. Eckman: Division of General Internal Medicine, University of Cincinnati Medical Center, PO Box 670535, 231 Albert Sabin Way, Cincinnati, OH 45267-0535.

Dr. Erban: Division of Hematology/Oncology, New England Medical Center, Box 542, 750 Washington Street, Boston, MA 02111.

Dr. Singh: Division of Cardiology, New England Medical Center, Box 079, 750 Washington Street, Boston, MA 02111.

Dr. Kao: Division of Transfusion Medicine, Harvard Joint Program in Transfusion Medicine, Dana-Farbar Cancer Institute, 44 Binney Street, D 530, Boston, MA 02115.


Ann Intern Med. 2003;138(3):W-15–W-24. doi:10.7326/0003-4819-138-3-200302040-00011-w1
Text Size: A A A

Background: Numerous tests are available to assess patient risk for bleeding or thrombosis. Appropriate use of these tests must involve consideration of the clinical setting, disease prevalence, performance characteristics of the tests, cost, and consequences of false-positive and false-negative results.

Purpose: To summarize information about coagulation testing in three common clinical settings: nonsurgical hospitalized patients, surgical patients, and patients having a first venous thromboembolic event.

Data Sources: All English-language studies identified in searches of MEDLINE (1966 to April 2002) and reference lists of key articles.

Study Selection: All published studies of blood coagulation testing as routine diagnostic tests or in the preoperative care of patients reporting postoperative bleeding complications, and all published studies of patients with the factor V Leiden mutation reporting venous thromboembolic outcomes.

Data Extraction: 5 observational studies of routine coagulation testing in nonsurgical hospitalized patients and 12 observational studies of preoperative coagulation testing, from which both sensitivity and specificity could be calculated.

Data Synthesis: Test performance characteristics for the partial thromboplastin time in predicting postoperative hemorrhage were pooled by type of surgery. Likelihood ratios for positive and negative results were calculated for each group; 95% confidence intervals were calculated. Patients with prolonged partial thromboplastin times did not have a statistically significantly increased risk for postoperative complications.

Conclusion: For nonsurgical and surgical patients without synthetic liver dysfunction or a history of oral anticoagulant use, routine testing has no benefit in assessment of bleeding risk. Routine testing after a first episode of venous thromboembolism is not recommended for most patients.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)