Perioperative Disorders of Primary Hemostasis: Determination and Treatment

SUMMARY Primary hemostasis, the first phase of hemostasis after vessel injury, is a complex process involving the platelets and resulting in the formation of the platelet plug that forms the basis for further coagulation (secondary hemostasis). Perioperative bleeding complications are often due to disorders of primary hemostasis. With respect to detection and treatment, functional platelet disorders are a greater problem than thrombocytopenia. Therefore, routine screening tests for primary hemostasis appear to be more important than those usually performed on plasmatic coagulation. Among the various diagnosis tools for the evaluation of primary hemostasis, platelet count and the Platelet Function Analyser (PFA‐100) with epinephrine are sensitive and specific for the detection of primary hemostasis disorders, whereas TEG is only appropriate to detect those caused by thrombocytopenia. Screening tests for primary hemostasis should at least be performed before major or complicated operations. The administration of platelet‐inhibiting drugs before and shortly after surgery should be avoided or stopped in time. Most disorders of primary hemostasis caused by impairment of platelet function can be successfully treated with desmopressin alone or in combination with antifibrinolytics. Platelet count and the PFA‐100 with epinephrine are well‐suited to document therapeutic effect and guide the use of these agents that can considerably reduce the need for platelet transfusion and prevent bleeding complications.