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Abstract
Thrombocytopenia is a common perioperative clinical problem. While global haemostasis
is influenced by many patient- and procedure-related factors, the contribution of
thrombocytopenia to bleeding risk is difficult to predict, as platelet count does
not linearly correlate with likelihood of bleeding. Thus, the widely used definition
of thrombocytopenia and grading of its severity have limited clinical utility. We
present a summary and analysis of the current recommendations for invasive procedures
in thrombocytopenic patients, although the platelet count at which any given procedure
may safely proceed is unknown. The benefits and risks of preoperative platelet transfusions
should be assessed on a patient-by-patient basis, and alternatives to platelet transfusion
should be considered. In non-emergent surgeries or in postoperative thrombocytopenic
patients, haematology consultation should be considered to guide diagnostics and management.
We present a pragmatic approach to the evaluation of perioperative thrombocytopenia.