Choosing Wisely:

Don’t perform routine preoperative hemostatic testing (PT, aPTT) in an otherwise healthy child with no prior personal or family history of bleeding.

Rationale and Comments: Preoperative hemostatic screening in healthy pediatric patients with no personal or family history of excessive bleeding does not effectively identify those who will have unexpected surgical bleeding. Artifacts or disorders that do not affect bleeding risk may be identified, such as factor XII deficiency or an infection-associated, transient lupus anticoagulant. Hemostatic testing adds cost and may introduce additional stress, either due to blood sampling or if a child has “abnormal” results.
Sponsoring Organizations:
  • American Society of Hematology
  • American Society of Pediatric Hematology/Oncology
  • Sources:
  • Expert consensus
  • Disciplines:
  • Pediatric
  • Hematologic
  • Surgical
  • References: • Alzahrani A, Othman N, Bin-Ali T, Elfaraidi H, Al Mussaed E, Alabbas F, Sedick Q, Albatniji F, Alshahrani Z, Asiri M, Alsuhaibani O, Elyamany G. Routine preoperative coagulation tests in children undergoing elective surgery or invasive procedures: are they still necessary? Clinical Medicine Insights: Blood Disorders. 2019 Jan;12:1-4.
    • Bidlingmaier C, Olivieri M, Hütker S, Dietl S, Kurnik K. Perioperative management of hemostasis in children and adolescents. Blood Cells, Molecules, and Diseases. 2017 Jan;67:91-95.
    • Chee YL, Crawford JC, Watson HG, Greaves M. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Committee for Standards in Haematology. British Journal of Haematology. 2008 Feb;140:496-504.
    • Cooper JD, Smith KJ, Ritchey AK. A cost-effectiveness analysis of coagulation testing prior to tonsillectomy and adenoidectomy in children. Pediatric Blood & Cancer. 2010 Dec;55(6):1153-1159.
    • Cosmi B, Alatri A, Cattaneo M, Gresele P, Marietta M, Rodeghiero F, Tripodi A, Ansaloni L, Fusari M, Taddei S. Assessment of the risk of bleeding in patients undergoing surgery or invasive procedures: guidelines of the Italian Society for Haemostasis and Thrombosis (SISET). Thrombosis Research. 2009 Nov;124(5):e6-e12.
    • Lescanne E, Chiron B, Constant I, Couloigner V, Fauroux B, Hassani Y, Jouffroy L, Lesage V, Mondain M, Nowak C, Orliaguet G, Viot A. Pediatric tonsillectomy: clinical practice guidelines. European Annals of Otorhinolaryngology, Head and Neck Diseases. 2012 Oct;129(5):264–271.
    • van Veen JJ, Spahn DR, Makris M. Routine preoperative coagulation tests: an outdated practice? British Journal of Anaesthesia. 2011 Jan;106(1):1-3.

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