Preoperative risk assessment for bleeding and thromboembolism

doi:10.1136/bmj.b2299

Published 3 September 2009, doi:10.1136/bmj.b2299
Cite this as: BMJ 2009;339:b2299

Practice

Rational Testing

Preoperative risk assessment for bleeding and thromboembolism

Donald M Arnold, assistant professor of medicine ¹^,3, Julia Anderson, associate professor of medicine, consultant haematologist¹^,2, Clive Kearon, professor of medicine¹

¹ Michael De Groote School of Medicine, McMaster University, Hamilton, ON, Canada , ² Department of Haematology, Royal Infirmary of Edinburgh, Edinburgh, ³ Canadian Blood Services, Hamilton, ON, Canada

Correspondence to: C Kearon, Hamilton Health Sciences, Henderson Division, 711 Concession Street, Hamilton, ON, Canada L8V 1C3 kearonc@mcmaster.ca

Personal and family histories are the most important assessmentsof a patient’s individual risk for bleeding and thrombosiswith surgery, and will often rule out the need for routine coagulationtesting

The first 150 words of the full text of this article appear below.

A 64 year old woman who is scheduled to have a total hip replacementis concerned that she may have a heightened risk of bleedingor thrombosis because she was told her father had died of a"clotting complication" after a car crash when he was 40 yearsold. It is not known if bleeding or pulmonary embolism was suspectedof contributing to her father’s death. The patient wouldlike to know if she should have testing before her surgery tofind out if she is at risk for bleeding or venous thromboembolism.

The next investigation depends on the patient’s personaland family history.

The first and the most important step in the assessment of apatient’s personal risk of bleeding (figure) and thrombosiswith surgery is to review the medical history and current drugs(use of anticoagulant or antiplatelet therapy, for example).