Background and goal of study: One of the main objectives of the preanesthesic evaluation is assessing the bleeding risk preoperatively. However, appropriate methods for ascertaining this risk remain subject to debate. A detailed history of bleeding and routine coagulation testing are used as a predictor for perioperative bleeding. The aim of our study is to describe the perioperative findings, management and outcome of patients with suspected coagulation disorders.

Materials and methods: Fifty-one patients were enrolled in this study. Medical history, physical examination and standard laboratory testing (APTT, PT/INR, platelet count) was performed to all patients. In addition special coagulation tests were requested and specific treatment was administrated if needed. There is a minimum follow-up on all patients of at least 3 months. 

Results and Discussion: Fifty-one ASA I – III patients evaluated in the preoperative program of Infanta Elena Hospital from September 2015 to September 2017, showed medical history y/or laboratory findings abnormalities: 10 patients (20%) referred bleeding history and 51 (100%) manifested abnormal coagulation tests. Fifty patients (98%) underwent specific tests and 29 (57%) patients were diagnosed with coagulation disorder: factor VII deficiency (6 patients), factor VIII deficiency (2 patients), Von Willebrand disease (4 patients), factor XI deficiency (2 patients), thrombocytopenia (3 patients), lupus anticoagulant (9 patients), coagulation altered for different reasons (3 patients). Twenty patients (39%) received treatment: Vitamin K preoperatively (8 patients), Tranexamic acid (4 patients), Desmopressin (3 patients) oral corticosteroids (2 patients) recombinant factor VII (1 patient), fresh frozen plasma (1 patient), platelet pool (1 patient). All patients with positive lupic anticoagulant had standard antithrombotic prophylaxis with low molecular weight heparin. Forty-eight patients (96%) underwent surgical intervention and only 5 (10%) presented adverse events during the follow up. 

Conclusions: Detection of coagulation disorders is crucial during the preoperative evaluation. Adequate treatment of important alterations ensures good outcome of potential life threatening or seriously disabling complications.

Acknowledgements: Assistance provided by Information Technology and Haematology Departments of Infanta Elena Hospital was greatly appreciated


04 / Perioperative management and outcome of patients with undiagnosed coagulation disorders.