Pre-operative hemostatic assessment and management

Excessive surgical bleeding can be predicted and then prevented in most patients with a recognised hereditary bleeding tendency or in those on anti-thrombotic therapy. However the clinical consultation of an individual patient can be challenging because the diagnosis can be unclear or a balance needs to be achieved between minimising bleeding without precipitating thrombosis. Laboratory testing does provide assistance in assessment of a bleeding tendency but it is not uncommon for the results to be inconclusive. Investigations such as the level of von Willebrand factor assays should be regarded as a continuous risk factor for surgical bleeding rather than defining a disease category. Appropriate replacement therapy prior to surgery is effective in preventing surgical bleeding. Aggressive anti coagulant therapy around the time of surgery in patients who usually are on warfarin more often lead to unnecessary haemorrhage rather than preventing further thrombosis. A risk assessment of both bleeding versus thrombosis for the particular operation is necessary to ensure the best outcome. (C) 2002 Published by Elsevier Science Ltd.