Rationale and Comments
The 1989 Medical Necessity Project of the Blue Cross and Blue Shield Association, endorsed by the American College of Physicians, found that at least 70% of prothrombin time and partial thromboplastin time tests were not clinically indicated. Subsequently, nine observational studies, including three prospective trials, reported that prothrombin time and partial thromboplastin time positive predictive values for bleeding complications ranged from 0.03 to 0.22, whereas computed 95% confidence intervals for each assay generates a 2.5% false-positive rate. A review of 27,737 prothrombin time and partial thromboplastin time results over two decades showed that only 8% of prothrombin times and partial thromboplastin times were clinically indicated based on current or prior patient history of bleeding. A study of general hospital unregulated coagulation screening requests produced few abnormal results with no evidence that they were associated with an increased bleeding risk. In this study, all bleeding cases could be attributed to an underlying condition. The risk of intraoperative bleeding is best predicted from a careful history that includes a questionnaire-based bleeding assessment test.
- American Society for Clinical Laboratory Science
- Prospective cohort studies
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