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Usefulness of standard plasma coagulation tests in the management of perioperative coagulopathic bleeding: is there any evidence?
Open accessAbstract
Standard laboratory coagulation tests (SLTs) such as prothrombin time/international normalized ratio or partial thromboplastin time are frequently used to assess coagulopathy and to guide haemostatic interventions. However, this has been challenged by numerous reports, including the current European guidelines for perioperative bleeding management, which question the utility and reliability of SLTs in this setting. Furthermore, the arbitrary definition of coagulopathy (i.e. SLTs are prolonged by more than 1.5-fold) has been questioned. The present study aims to review the evidence for the usefulness of SLTs to assess coagulopathy and to guide bleeding management in the perioperative and massive bleeding setting. Medline was searched for investigations using results of SLTs as a means to determine coagulopathy or to guide bleeding management, and the outcomes (i.e. blood loss, transfusion requirements, mortality) were reported. A total of 11 guidelines for management of massive bleeding or perioperative bleeding and 64 studies investigating the usefulness of SLTs in this setting were identified and were included for final data synthesis. Referenced evidence for the usefulness of SLTs was found in only three prospective trials, investigating a total of 108 patients (whereby microvascular bleeding was a rare finding). Furthermore, no data from randomized controlled trials support the use of SLTs. In contrast, numerous investigations have challenged the reliability of SLTs to assess coagulopathy or guide bleeding management. There is actually no sound evidence from well-designed studies that confirm the usefulness of SLTs for diagnosis of coagulopathy or to guide haemostatic therapy.
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“Coagulation studies have limitations to guide decision making related to blood transfusion in the context of abruption with significant hemorrhage (84).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [84]
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Metadata
- Authors
- Haas, T., Fries, D., Tanaka, K. A., Asmis, L., Curry, N. S., & Schöchl, H.
- Affiliations
- University Children's Hospital Zurich (CH)
- Innsbruck Medical University (AT)
- University of Pittsburgh Medical Center (US)
- Unilabs (Switzerland) (CH)
- Oxford University Hospitals NHS Trust (GB)
- Paracelsus Medical University (AT)
- Venue
- British Journal of Anaesthesia
- Publisher
- Elsevier BV
- Published
- 2015-02
- Volume
- 114
- Issue
- 2
- Pages
- 217-224
- ISSN
- 0007-0912 (ISSN-L)
- OpenAlex
- W2109382862
- Cited by
- 249
- References
- 74
- Citations by year
- 2026: 5 · 2025: 19 · 2024: 20 · 2023: 19 · 2022: 18 · 2021: 26 · 2020: 26 · 2019: 23 · 2018: 21 · 2017: 26 · 2016: 23 · 2015: 19
- FWCI
- 2.29
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- British Journal of Anaesthesia (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- reroDoc Digital Library (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Topics
- Health Sciences › Medicine › Hematology › Blood transfusion and management
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
- Health Sciences › Medicine › Hematology › Hemostasis and retained surgical items
- Keywords
- coagulopathy, perioperative bleeding, massive hemorrhage, prothrombin time, international normalized ratio, activated partial thromboplastin time, hemostatic therapy, blood transfusion, microvascular bleeding, diagnostic reliability
- MeSH terms
- Blood Coagulation Disorders, Blood Coagulation Tests, Hemorrhage, Humans, Intraoperative Complications, Postoperative Complications, Evidence-Based Medicine, Perioperative Care
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