| A practical concept for preoperative identification of patients with impaired primary hemostasis. | |
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MedLine Citation:
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PMID: 15247976 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The findings of a large prospective study designed to identify primary and/or secondary hemostatic disorders before surgical interventions are presented. A total of 5649 unselected adult patients were enrolled to identify impaired hemostasis before surgical interventions. Each patient was asked to answer a standardized questionnaire concerning bleeding history. Activated partial thromboplastin time (aPTT), prothrombin time (PT), and platelet counts (PC) including PFA-100 (platelet function analyzer): collagen-epinephrine (C/E), and collagen-ADP (C/ADP) were routinely done in all patients. Additional tests, bleeding time (BT), and von Willebrand factor (vWF: Ag) were performed only in patients with a positive bleeding history and/or evidence of impaired hemostasis; e.g., drug ingestion. The bleeding history was negative in 5021 patients (88.8%) but positive in the remaining 628 (11.2%). Impaired hemostasis could be verified only in 256 (40.8%) of these patients. The vast majority were identified with PFA-100: C/E (n=250; 97.7%). The other six patients with impaired hemostasis were identifiable solely based on the PT (n=2), PFA-100: C/ADP (n=2), and vWF: Ag (n=2). The PFA-100: C/ADP detected 199 patients (77.7%). The only abnormality found among patients with a negative bleeding history was a prolonged aPTT due to lupus anticoagulant in nine patients (0.2%). The sensitivity of the PFA-100: collagen-epinephrine was the highest (90.8%) in comparison to the other screening tests (BT, aPTT, PT, vWF: Ag). The positive predictive value of the PFA-100: collagen-epinephrine was high (81.8%), but the negative predictive value was higher (93.4%). The use of a standardized questionnaire and, if indicated, the PFA-100: C/E and/or other specific tests not only ensure the detection of impaired hemostasis in almost every case but also a significant reduction of the cost. |
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Authors:
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Juergen Koscielny; Sabine Ziemer; Hartmut Radtke; Michael Schmutzler; Axel Pruss; Pranav Sinha; Abdulgabar Salama; Holger Kiesewetter; Reinhard Latza |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis Volume: 10 ISSN: 1076-0296 ISO Abbreviation: Clin. Appl. Thromb. Hemost. Publication Date: 2004 Jul |
Date Detail:
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Created Date: 2004-07-12 Completed Date: 2004-10-18 Revised Date: 2009-11-19 |
Medline Journal Info:
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Nlm Unique ID: 9508125 Medline TA: Clin Appl Thromb Hemost Country: United States |
Other Details:
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Languages: eng Pagination: 195-204 Citation Subset: IM |
Affiliation:
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Institute for Transfusion Medicine, Charité Humboldt-University, Schumannstr. 20/21, 10117 Berlin, Germany. juergen.koscielny@charite.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Antigens / analysis Blood Coagulation / drug effects Blood Coagulation Disorders / blood, diagnosis*, epidemiology, genetics Blood Coagulation Tests Collagen / pharmacology Epinephrine / pharmacology Female Fibrinogen Humans Male Mass Screening Medical Records Middle Aged Partial Thromboplastin Time Platelet Activation / drug effects Platelet Function Tests / instrumentation Predictive Value of Tests Preoperative Care / methods* Prevalence Prospective Studies Questionnaires ROC Curve Sensitivity and Specificity Surgical Procedures, Elective Thrombophilia / blood, diagnosis, epidemiology von Willebrand Factor / immunology |
| Chemical | |
Reg. No./Substance:
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0/Antigens; 0/Von Willebrand antigen; 0/von Willebrand Factor; 51-43-4/Epinephrine; 9001-32-5/Fibrinogen; 9007-34-5/Collagen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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