Sensitivity and specificity of strategies to identify patients with hemostasis abnormalities leading to an increased risk of bleeding before scheduled intervention: the Hemorisk study

IF 5.5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis Pub Date : 2024-08-10 DOI:10.1016/j.jtha.2024.07.024

Nadine Ajzenberg , Dan Longrois , Dorothée Faille , Christian de Tymowski , Emmanuelle De Raucourt , Larbi Boudaoud , Stéphanie Sigaut , Isabelle Martin-Toutain , Mathieu Raux , Dominique Helley , Julien Josserand , Claire Flaujac , Jérome Duchemin , Charles-Marc Samama , Isabelle Gouin-Thibault , Hélène Beloeil , Edith Peynaud-Debayle , Hawa Keita-Meyer , Marie-Charlotte Bourrienne , Caroline Quintin , Florence Tubach

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引用次数: 0

Abstract

Background

Preoperative identification of patients with hemostasis abnormalities leading to an increased bleeding risk is based on routine hemostasis tests: prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet count. Because of their low predictive performance, guidelines recommend replacing them with structured bleeding risk questionnaires, but none is validated in this population.

Objectives

To assess the diagnostic accuracy of 3 strategies, performed at the preanesthesia visit before scheduled interventions, and to identify patients with hemostasis abnormalities leading to an increased bleeding risk

Methods

A multicenter study was performed in 7 French academic hospitals, involving patients scheduled for surgical intervention, without antiplatelet/anticoagulant treatment. The 3 strategies consisted of 1-a structured screening questionnaire; 2-PT, APTT, and platelet count ordered in selected patients; and 3-systematic PT, APTT, and platelet count. The reference standard comprised von Willebrand factor activity/antigen, factor (F)VIII, FIX, FXI, platelet function analyzer, and, when required, FII, FV, FX, and FVII and hemostasis consultation.

Results

Eighteen (1.2%) of 1484 patients had a hemostasis abnormality leading to an increased bleeding risk according to reference standard. In the overall cohort, sensitivity of the questionnaire-based strategy was 50% (95% CI, 26%-74%; specificity, 87% [95% CI, 85%-88%]); sensitivity was 0% (95% CI, 0%-41%) in men vs 82% (95% CI, 48%-98%) in women. For selective routine tests, sensitivity was 33% (95% CI, 13%-59%) and specificity 97% (95% CI, 96%-98%). Corresponding values for systematic routine tests were 44% (95% CI, 22%-69%) and 93% (95% CI, 91%-94%).

Conclusion

Sensitivity was low for all 3 strategies investigated. The structured screening questionnaire had clinically acceptable diagnostic accuracy only in women.

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在计划干预前识别止血异常导致出血风险增加的患者策略的敏感性和特异性：Hemorisk 研究。

背景：术前通过常规止血检测：凝血酶原时间（PT）、活化凝血酶原时间（aPTT）和血小板计数来识别有止血异常并导致出血风险增加的患者。由于这些方法的预测性较低，指南建议用结构化出血风险问卷取代它们，但没有一种方法在这一人群中得到验证：目的：评估在麻醉前就诊时，在预定的介入治疗前进行的 3 种策略的诊断准确性，以确定有止血异常并导致出血风险增加的患者患者和方法：在法国 7 家学术医院进行的多中心研究，涉及预定进行外科介入治疗的患者，他们未接受抗血小板/抗凝治疗。3种策略包括：1-结构化筛查问卷；2-对选定患者进行PT、aPTT和血小板计数检查；3-系统性PT、aPTT和血小板计数检查。参考标准包括冯-威廉因子活性/抗原、因子 VIII、IX 和 XI、血小板功能分析仪，必要时还包括 FII、FV、FX 和 FVII 以及止血咨询：根据参考标准，1484 名患者中有 18 人（1.2%）出现止血异常，导致出血风险增加。在整个队列中，基于问卷调查策略的灵敏度为 50%（95%CI，26-74；特异性为 87%（95%CI，85-88）；男性的灵敏度为 0（95%CI，0-41），而女性的灵敏度为 82%（95%CI，48-98）。选择性常规检测的敏感性为 33%（95%CI，13-59），特异性为 97%（95%CI，96-98）。系统性常规检测的相应数值分别为 44% (95%CI, 22-69) 和 93% (95%CI, 91-94)：所有 3 种调查策略的灵敏度都较低。结构化筛查问卷仅对女性具有临床可接受的诊断准确性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

期刊介绍： The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.