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The Preoperative Bleeding Time Test Lacks Clinical Benefit
College of American Pathologists' and American Society of Clinical Pathologists' Position Article
Powers Peterson, MD;
Timothy E. Hayes, MD, DVM;
Charles F. Arkin, MD;
Edwin G. Bovill, MD;
Robert B. Fairweather, MD;
William A. Rock, Jr, MD;
Douglas A. Triplett, MD;
John T. Brandt, MD
Arch Surg. 1998;133:134-139.
The major conclusions of this position article are as follows: (1) In the absence of a history of a bleeding disorder, the bleeding time is not a useful predictor of the risk of hemorrhage associated with surgical procedures. (2) A normal bleeding time does not exclude the possibility of excessive hemorrhage associated with invasive procedures. (3) The bleeding time cannot be used to reliably identify patients who may have recently ingested aspirin or nonsteroidal anti-inflammatory agents or those who have a platelet defect attributable to these drugs. The best preoperative screen to predict bleeding continues to be a carefully conducted clinical history that includes family and previous dental, obstetric, surgical, traumatic injury, transfusion, and drug histories. A history suggesting a possible bleeding disorder may require further evaluation; such an evaluation may include performance of the bleeding time test, as well as a determination of the platelet count, the prothrombin time, and the activated partial thromboplastin time. In the absence of a history of excessive bleeding, the bleeding time fails as a screening test and is, therefore, not indicated as a routine preoperative test.
From the Departments of Pathology, Cornell University Medical College, New York, NY (Dr Peterson); Maine Medical Center, Portland (Dr Hayes); University of Vermont College of Medicine, Burlington (Dr Bovill); Dartmouth-Hitchcock Medical Center, Lebanon, NH (Dr Fairweather); University of Mississippi Medical Center, Jackson (Dr Rock); Ball Memorial Hospital, Muncie, Ind (Dr Triplett); and Ohio State University College of Medicine, Columbus (Dr Brandt); and the Department of Laboratory Medicine, Boston University Medical Center, Boston, Mass (Dr Arkin). Dr Peterson is now with the Department of Pathology and Laboratory Medicine, Medical College of Pennsylvania and Hahnemann University School of Medicine, Allegheny University of the Health Sciences, Philadelphia.
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