The bleeding time has also been used to assess other forms of intervention in patients with uremia. Several studies have shown that the bleeding time decreases following the intravenous or subcutaneous administration of desmopressin acetate within 4 to 6 hours.76 The bleeding time has also been used to monitor the response to cryoprecipitate or conjugated estrogens.42,77,78 In all these reports, there is anecdotal evidence that correction of the bleeding time was associated with decreased clinical bleeding. Indeed, it has been suggested that the bleeding time may be the best indicator of bleeding risk in patients with uremia.43 Other studies evaluating the relationship between bleeding of widely varying severity and prolongation of the bleeding time have failed to establish the use of the bleeding time for the prediction of clinically severe bleeding in advance of its occurrence.44,45,79,80 In particular, the study by Eknoyan et al44 showed that a decline in prothrombin consumption was more predictive of bleeding than any other parameter studied, including the bleeding time. Although some studies have shown a reasonable correlation between the bleeding time and "clinical" bleeding (as distinguished from "surgical" bleeding) in patients with uremia, no controlled study has shown that patients with prolonged bleeding times have more clinically significant complications than those with normal bleeding times.1,2,22,43 Thus, the bleeding time may be useful for monitoring the response to therapy in patients with uremia. However, there is little direct evidence indicating that the bleeding time can be used to predict the risk of bleeding in these patients, particularly in a patient undergoing an invasive procedure.