Le bilan d'hémostase avant une intervention est-il inutile ?

Haemostasis testing is still widely practiced in an attempt to assess perioperative bleeding risk before a surgery or other invasive procedure such as endoscopy or neuraxial anaesthesia. However, standard haemostatic tests (including activated partial thromboplastin time, prothrombin time and platelet count) are poor predictors of perioperative bleeding risk, and their results when systematically prescribed do not change medical management. The recently published guidelines are to not prescribe routine coagulation screening to patients whose history and clinical examination suggest no haemostatic disorder. Haemostatic assessment should be based on personal and family history of haemorrhagic diathesis, and based on surgical and traumatic history. Haemostatic testing should be reserved for patients suspected of haemostasis disorder increasing bleeding risk, for patients whose bleeding history is impossible or uninformative, for patients with a known coagulopathy, and for the rare surgical conditions requiring reference values for postoperative management.