OBJECTIVE To assess the value of pre-operative coagulation testing in elective surgical patients, to estimate the frequency of abnormality and the outcome in relation to transfusion. METHODS Observational study. METHODS The study was performed at the Aga Khan University Hospital in main operating room over a period of six months from March to September 1999. METHODS All patients scheduled for elective surgery in which the primary physician had ordered PT (prothrombin time), APTT (activated partial thromboplastin time) and PLT (platelet) count were included. Risk groups were made based on history of coagulation disorders and medications altering coagulation. The patients were also stratified according to age and the frequency of abnormality determined in different groups. RESULTS Five hundred cases were studied. The frequency of abnormalities of PT and APTT were found to have statistically high association with the risk groups based on history. There was significant association between age and abnormal platelets count. Only 8 patients were transfused. CONCLUSIONS Pre-operative coagulation tests should only be ordered in high risk groups based on history and examination.