This evaluation can be done expeditiously through Electronics-consults (E-consults).
Purpose: To expedite and ensure safety of surgical procedure for patients who have abnormal coagulation test.
Background: There are arguments about the usefulness of routine coagulation test in preventing bleeding during surgery. These test often cause unnecessary further testing and delays of surgery. However, the surgical services and urology department at the Atlanta VAMC routinely request screening PT/aPTT for pre-operative patients. There are multiple factors that could influence the PT and aPTT not limited to factors deficiencies, inhibitors, etc.
Methods: We reviewed 26 hematology E-consults for abnormal coagulation from Surgery and Urology department. 23 males patients undergoing surgical or urological procedure have prolong aPTT with normal PT. 3 males patients undergoing urological procedure have prolonged PT but normal aPTT.
Results: 92% of patients with prolong aPTT had normal workup test results. 8% with prolong aPTT had abnormal workup leading to the diagnosis of Hemophilia A and positive lupus anticoagulant. 100% with prolong PT had normal workup test result.
Implications: The vast majority of the results of these routine coagulation test are false positive. However, a very small percentage is diagnosed with mild bleeding disorder that in some case will require intervention to prevent bleeding at the time of the surgical procedure. In the case of the patient with mild Hemophilia A (33% of FVIII level) he was given recombinant factor VIII infusion on the day of the procedure. The patient with positive anticoagulant, did not have history of thromboembolic events, therefore no intervention was taken prior to the procedure. Hematology E-consults at the Atlanta VA are answered within 24 hrs; therefore, consultations for abnormal coagulation do not cause any delay in the surgical planning besides the waiting time for the test’s results to be available.