Medical assessment of bleeding in the surgical patient.

The key to avoidance of hemostatic failure during surgery is to be able to identify the high-risk patient and make a diagnosis and treat the defect before surgery. A thorough history and physical examination are mandatory in this regard. A screening coagulation profile is not a substitute for the history and physical examination. Selected presurgical tests are useful in major surgical cases and in certain high-risk cases. Otolaryngologists have advised presurgical testing for patients undergoing tonsillectomy, but the subject of presurgical testing is still a matter for investigation in view of the necessity for cost containment. Knowledge of the hemostatic system combined with a knowledge of the tests available to diagnose coagulation defects permits a rational approach to therapy of the bleeding surgical patient.