Detection of inherited and acquired hemostatic disorders in surgical patients

Excerpt

In this issue of the Journal, Bonhomme et al. 1 propose a structured questionnaire (HEMSTOP; Hematoma, hEmorrhage, Menorrhagia, Surgery, Tooth extraction, Obstetrics, Parents) to facilitate preoperative identification of surgical patients with hemostatic disorders requiring specific measures to reduce perioperative bleeding. The HEMSTOP is a seven-point questionnaire, with each question requiring a simple yes/no answer to attain a score from 0-7 depending on the number of positive answers. The authors retrospectively assessed the HEMSTOP questionnaire in patients referred to hemostasis specialists. These specialists subsequently recommended whether or not hemostatic precautions were required in these patients prior to surgery. Additionally, the authors prospectively tested the HEMSTOP questionnaire in healthy volunteers. The authors identified a cut-off value of 2 or higher for the HEMSTOP score, which yielded a sensitivity of 89.5% and a specificity of 98.6% for the diagnosis of a bleeding disorder. Assuming a prevalence of bleeding disorders of 1%, these values correspond to a negative predictive value of 99.9% and a positive predictive value of 39.1%. Importantly, the questionnaire was not intended to identify bleeding disorders related to ongoing medications and known pathological conditions associated with increased bleeding risk. Therefore, the clinical utility of the HEMSTOP questionnaire should be considered within the context of preoperative detection of as yet undiagnosed (and therefore likely mild) inherited or acquired bleeding disorders unrelated to more well-known pathological conditions associated with disrupted hemostasis. …