Assessing preoperative bleeding risk using international normalized ratio and activated partial thromboplastin time: a systematic review.

BACKGROUND

The prothrombin time (PT) and activated partial thromboplastin time (APTT) are often considered routine tests in the assessment of perioperative bleeding risk. Physicians continue to order these tests, and major medical societies guidelines exhibit significant heterogeneity regarding the utility of coagulation tests as a general screening tool, despite many advocating for a risk-stratified approach over routine testing.

OBJECTIVES

This study aimed to assess for association between preoperative coagulation tests and bleeding events around elective surgery.

METHODS

We conducted a systematic review of the literature. Three electronic databases were consulted MEDLINE, EMBASE, and EBM Reviews. Randomized trials and observational studies that assessed the predictive accuracy of preprocedural PT and APTT test results for perioperative bleeding were deemed eligible for inclusion. Outcomes included any bleeding events in the postoperative period.

RESULTS

In total, 100 studies were included in our qualitative synthesis: otolaryngology (n = 15), minor surgeries and procedures (n = 15), neurosurgery (n = 17), orthopedic surgeries (n = 6), cardiac surgeries (n = 16), liver transplantation or hepatectomy (n = 20), general surgery, and other types of major surgery (n = 11). Qualitative synthesis demonstrated a weak or inconsistent association between PT or APTT and bleeding events. Associations were more frequently reported in studies involving patients with cirrhosis and/or neoplastic disease of the liver undergoing liver resection, transplantation, or major abdominal cancer debulking surgery.

CONCLUSION

Our findings confirm that coagulation testing results are not consistently associated with bleeding in minor surgeries and nearly all major elective surgeries. However, PT results might be associated with bleeding outcomes in patients with advanced liver disease undergoing major abdominal surgeries.