Coagulation testing has long been part of the routine assessment of the preoperative patient, with the aim of identifying those with a bleeding disorder who might suffer significant perioperative bleeding. Some of the issues surrounding this involve the low prevalence of bleeding disorders in the general population, and the implications of further testing for both the patient and the health-care system. Studies suggest that this practice is not evidence based and is considered to be outdated. Most guidelines now advise against routine coagulation screens before surgery, and instead recommend taking a thorough personal and family history of bleeding in order to determine the need for further investigations. This review analyses current evidence on this topic and provides a comprehensive view of the relevance of preoperative coagulation testing.