Peterson P, Hayes T E, Arkin C F, Bovill E G, Fairweather R B, Rock W A, Triplett D A, Brandt J T
Department of Pathology, Cornell University Medical College, New York, NY, USA.
Arch Surg. 1998 Feb;133(2):134-9. doi: 10.1001/archsurg.133.2.134.
The major conclusions of this position article are as follows: (1) In the absence of a history of a bleeding disorder, the bleeding time is not a useful predictor of the risk of hemorrhage associated with surgical procedures. (2) A normal bleeding time does not exclude the possibility of excessive hemorrhage associated with invasive procedures. (3) The bleeding time cannot be used to reliably identify patients who may have recently ingested aspirin or nonsteroidal anti-inflammatory agents or those who have a platelet defect attributable to these drugs. The best preoperative screen to predict bleeding continues to be a carefully conducted clinical history that includes family and previous dental, obstetric, surgical, traumatic injury, transfusion, and drug histories. A history suggesting a possible bleeding disorder may require further evaluation; such an evaluation may include performance of the bleeding time test, as well as a determination of the platelet count, the prothrombin time, and the activated partial thromboplastin time. In the absence of a history of excessive bleeding, the bleeding time fails as a screening test and is, therefore, not indicated as a routine preoperative test.
(1) 在没有出血性疾病病史的情况下,出血时间并非手术相关出血风险的有效预测指标。(2) 正常的出血时间不能排除与侵入性操作相关的过度出血可能性。(3) 出血时间不能可靠地识别近期可能服用过阿司匹林或非甾体类抗炎药的患者,或那些因这些药物导致血小板缺陷的患者。预测出血的最佳术前筛查方法仍然是仔细询问临床病史,包括家族史以及既往的牙科、产科、手术、创伤性损伤、输血和用药史。提示可能存在出血性疾病的病史可能需要进一步评估;这种评估可能包括进行出血时间测试,以及测定血小板计数、凝血酶原时间和活化部分凝血活酶时间。在没有过度出血病史的情况下,出血时间作为筛查试验是失败的,因此,不建议作为常规术前检查。