Preoperative bleeding risk

This algorithm does not apply to emergency surgery, people taking anticoagulants or antiplatelet agents, or people who are pregnant, all of which are discussed separately in UpToDate. Refer to topics on perioperative anticoagulation, preoperative medication management, and pregnancy for details. Female relatives of an individual with hemophilia A or B may have reduced factor levels and should be tested for the relevant factor.

aPTT: activated partial thromboplastin time; BAT: bleeding assessment tool; eGFR: estimated glomerular filtration rate; ITP: immune thrombocytopenia; PT: prothrombin time; SLE: systemic lupus erythematosus; VWD: von Willebrand disease.

* The bleeding assessment tool (BAT) quantifies replies to standard questions about bleeding risk and is useful to determine the need for additional evaluations. An online tool is available (ISTH-BAT). Some preoperative checklists may incorporate similar questions as part of a preoperative screening tool. Refer to UpToDate for a discussion of preoperative hemostasis testing.

¶ Several underlying conditions can increase bleeding risk and may warrant additional testing:

Liver disease – Low clotting factor levels, dysfibrinogenemia, thrombocytopenia.
Kidney disease – Platelet dysfunction and exposure to anticoagulant drugs during dialysis.
Cancer or cancer therapy – Cancer and/or cancer therapy can cause myelosuppression and thrombocytopenia and/or impaired platelet function. Some people with limited stage solid tumors may not be at substantially increased risk of thrombocytopenia or platelet dysfunction.

Graphic 143968 Version 1.0

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Preoperative bleeding risk