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Bleeding time and bleeding: an analysis of the relationship of the bleeding
time test with parameters of surgical bleeding
R De Caterina, M Lanza, G Manca, GB Strata, S Maffei and L Salvatore
CNR Institute of Clinical Physiology, Spedali Riuniti di Santa Chiara,
Pisa, Italy.
The bleeding time is currently the only clinically available comprehensive
test to explore primary hemostasis. It is currently performed mostly as a
screening procedure before surgery, to detect otherwise unknown defects in
platelet-vessel wall interactions, but its use in this specific setting has
been seriously questioned by recent reanalyses of previously published
literature. We studied the relationship of the bleeding time from a
standardized cutaneous incision with other parameters of bleeding derived
from the analysis of the bleeding time curve and prospectively investigated
possible correlations of these alternative parameters, as well as of the
bleeding time, with a number of indices of actual bleeding during or after
coronary bypass surgery. Four parameters (bleeding time, total bleeding,
peak bleeding rate, and time to peak bleeding) were derived from the
analysis of bleeding time curves measuring blood losses from a standardized
cutaneous incision at 30-second intervals in 118 subjects. Parameters from
the bleeding time curve were subsequently obtained in duplicate as a
preoperative assessment in 40 patients with a negative bleeding history and
no recent intake of non-steroidal anti- inflammatory drugs who were
undergoing elective pure coronary bypass surgery performed by the same
operator. These parameters were correlated in simple linear regression
analysis with estimates of surgical bleeding (chest tube drainage,
transfusion requirements, percentage of hematocrit, percentage of platelet
level decrease, and times to hematocrit and platelet level nadir) and then,
in multiple regression analysis, with indices of operation complexity
(number of bypasses, total duration of the operation, and duration of the
extracorporeal circulation). Bleeding time was significantly correlated,
among parameters derived from the bleeding time curve, with total bleeding
and peak bleeding rate, but not with time to peak bleeding. Bleeding time,
total bleeding, and peak bleeding rate were similarly affected by acute
interventions with intravenous aspirin (500 mg) and sublingual
nitroglycerin (0.3 mg). None of these parameters, which were obtained in
duplicate in each patient preoperatively, was significantly related to
actual indices of bleeding at surgery. Thus, in patients with a negative
history of bleeding and no recent intake of non-steroidal anti-inflammatory
drugs, higher values for bleeding time and bleeding time-related parameters
are not associated with higher indices of perioperative and postoperative
bleeding at coronary bypass surgery. Therefore, we do not recommend the use
of the test in this setting to predict perioperative or postoperative
bleeding.
Volume 84,
Issue 10,
pp. 3363-3370,
11/15/1994
Copyright © 1994 by The American Society of Hematology
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