Preoperative Clinical Assessment of Hemostatic Function in Patients Scheduled for a Cardiac Operation

Background. Bleeding during and after cardiac operations is usually attributed to inadequate surgical hemostasis or cardiopulmonary bypass-induced disorders of hemostasis. Patient-related factors often are neglected. Methods. Articles published between 1976 and 1996 on the preoperative assessment of surgical patients were reviewed to determine the clinical elements most likely to predict increased perioperative blood requirements. Results. Preoperative assessment is based on a carefully conducted interview (history of bruising, petechiae, recent or excessive bleeding after operation, chronic drug therapy) and physical examination. A standardized questionnaire to enhance the reliability of the assessment is presented. Thus, patients at high risk of being transfused can be identified early on and may be enrolled in various programs designed to decrease bleeding and the need for allogeneic blood transfusions. Conclusions. Clinical assessment of hemostatic function before cardiac operations is both effective and efficient. It obviates the need for routine laboratory testing and favors the introduction of blood conservation strategies early on during the process of care.