Clinical Impact of Bleeding Time and Concordance with Platelet Function Analysis at a Single Academic Institution

Abstract

Abstract Introduction/Objective Bleeding time (BT) was historically used as a screening test to evaluate in vivo primary hemostasis. However, various disadvantages of BT and development of tests such as the platelet function analysis (PFA) contributed towards a discontinuation of its use at many hospitals. As our institution continues to offer BT, we sought to determine the concordance rate of BT with other coagulation tests and its clinical effectiveness. Methods/Case Report BT tests from 2014 to 2020 at our institution were evaluated. Results from BT were compared with those from concurrently ordered PFA. A chart review was performed to analyze the effect of BT on patient outcomes, defined as determiningsurgical/medical management or changing the patient’s diagnosis. Results (if a Case Study enter NA) From 2014-2020, there were 71 BT orders. There were 22 concurrently ordered PFAs. BT and PFA results were concordant in 14 of 22 instances with 4 of 14 being abnormal while 10 of 14 were normal. In terms of clinical outcomes, after removing five cases from analysis for lack of data, BT had a significant clinical impact in 25 of 66 cases, 20 of 25 determining surgical/medicalmanagement and 5 of 25 changing the patient’s diagnosis. After the release of ASCP’s Choosing Wisely guidance on BT in 2014, the number of BT ordered dropped from 35 in 2014 to 13 in 2015. Conclusion At our institution, most BT orders were ordered to assess bleeding risk prior to procedures or to find a cause for bleeding of unknown origin; however, BT affected clinical outcomes in less than half of cases. BT and PFA generally correlated well. Following guidance published by professional groups, including ASCP’s Choosing Wisely, BT utilization saw a decrease.