Can we predict bleeding?

The prior identification of subjects who are likely to bleed excessively when subjected to operative surgery and other invasive procedures is desirable. Frequently, reliance is placed on laboratory-based screening tests of blood coagulation for this purpose. However, published evidence does not support this approach as the tests are not fit for purpose, and their sensitivity and specificity are low. Some more global assays may have use in the diagnostic workup in subjects with hemorrhage, but none has been established to date as an efficient method for prediction of bleeding in unselected populations. There is renewed interest in the use of the clinical history for the prediction of bleeding. Recent reports suggest that when a structured questionnaire is employed to derive a bleeding score, the positive predictive value of the approach for the detection of bleeding disorders is high.