The preoperative bleeding time test: assessing its clinical usefulness
Amy S. Gewirtz, MDAddress reprint requests to A.S.G., Department of Anatomic Pathology, L25, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Kandice Kottke-Marchant, MD, PhD
Michael L. Miller, DO
The bleeding time test can aid in the diagnostic evaluation of patients with clinical hemorrhagic disorders or a history of bleeding. However, its low positive predictive value in predicting perioperative bleeding should force one to abandon it as a routine preoperative screening test.KEY POINTS
Many methodologic factors affect the bleeding time, including the length, depth, orientation, and location of the incision and whether a blood pressure cuff is used. The bleeding time also varies with age, sex, blood group, medication use, skin characteristics, and diet.
A prolonged bleeding time itself is nonspecific and is not pathognomonic of a single disease entity.
Many studies have shown no association between a prolonged preoperative bleeding time and increased perioperative blood loss.
Even though a prolonged preoperative bleeding time usually lacks clinical significance, it often leads to additional laboratory tests, postponement of surgery, increased length of stay, and possibly inappropriate treatment.