Risk of post-operative hemorrhage after adenoidectomy and tonsillectomy: Value of the preoperative determination of partial thromboplastin time and prothrombin time

Bitar, Mohamad; Dunya, Gabriel; Khalifee, Elie; Muwakkit, Samar; Barazi, Randa

doi:10.1016/j.ijporl.2018.10.024

Cited by 17 publications

(14 citation statements)

References 14 publications

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“…The clinical practice for including APTT in preoperative screening varies, and it is an area of controversy. [43][44][45][46][47] On one hand, there are several reservations about an increased use of APTT in the preoperative setting: First, the preoperative debut of an isolated prolonged APTT due to underlying lupus anticoagulants may lead to unnecessary delay of a needed surgical intervention or invasive procedure.…”

Section: Preoper Ative De Termination Of Ap T T-pros and Con Smentioning

confidence: 99%

Unexpected, isolated activated partial thromboplastin time prolongation: A practical mini‐review

Rasmussen

Philips

Tripodi

et al. 2020

European J of Haematology

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A common inquiry in coagulation laboratories is how to interpret an unexpected, isolated prolonged activated partial thromboplastin time (APTT). In this context, isolated means together with a normal prothrombin time (PT) and/or normal international normalized ratio (INR). This finding may lead to contact with laboratory doctors for further advice on a diagnostic strategy. Occasionally, the need for a diagnostic algorithm can be subacute, where surgery has to be postponed until an explanation for the isolated, prolonged APTT has been established. Activated partial thromboplastin time as a coagulation test was developed to monitor patients with hemophilia.Different APTT reagents display considerable differences in their sensitivity to deficiencies of coagulation factors. An isolated, prolonged APTT is seen in (a) individuals/patients with lupus anticoagulants, (b) patients in treatment with anticoagulants, mainly heparin, and (c) patients with deficiencies of specific coagulation factors. In this tutorial review, we summarize what may cause an isolated prolonged APTT and we present a simple diagnostic algorithm to differentiate between lupus anticoagulants (common) and factor deficiencies (rare). The identification of an isolated prolonged APTT as well as the underlying cause can be of the utmost importance in ensuring the correct therapeutic follow-up. K E Y W O R D Sactivated partial thromboplastin time, hemophilia, lupus anticoagulants

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Section: Preoper Ative De Termination Of Ap T T-pros and Con Smentioning

confidence: 99%

Unexpected, isolated activated partial thromboplastin time prolongation: A practical mini‐review

Rasmussen

Philips

Tripodi

et al. 2020

European J of Haematology

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“…Coagulation tests, especially thrombin time (TT), partial thromboplastin time (PTT) or activated partial thromboplastin time (APTT) were regularly used to predict PTH. Despite many attempts, none of these parameters showed to a have a potential to predict PTH or RTT, but are still commonly used …”

Section: Introductionmentioning

confidence: 99%

“…Despite many attempts, none of these parameters showed to a have a potential to predict PTH or RTT, but are still commonly used. 1,6,7 Fibrinogen is one of the most important acute-phase proteins with pivotal functions in acute pro-inflammatory immune reaction and the blood coagulation cascade. 8 Fibrinogen production by hepatocytes is stimulated by pro-inflammatory cytokines, like interleukin-1ß and interleukin-6 and plasma fibrinogen concentrations usually range between 2 and 4 mg/mL.…”

Section: Introductionmentioning

confidence: 99%

Preoperative plasma fibrinogen as a predictive factor for post‐tonsillectomy haemorrhage

Grasl

Janik

Vyskocil

et al. 2019

Clinical Otolaryngology

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Objectives To assess whether preoperative plasma fibrinogen is able to predict severe post‐tonsillectomy haemorrhage. Study design Retrospective chart review. Methods We included 456 patients who underwent tonsillectomy between 2008 and 2013. Preoperative plasma fibrinogen levels (PFL) were assessed in patients who developed severe bleeding requiring surgical revision under general anesthesia compared to those with uneventful postoperative courses. Results 414 (90.8%) had no severe post‐tonsillectomy haemorrhage. In contrast, 42 (9.2%) patients needed surgical hemostasis. PFL were significantly higher (P = .023) in patients with a severe bleeding. Univariate Cox‐regression analysis revealed that elevated preoperative fibrinogen represents a significant worse (P = .003; HR 2.66; 95% CI 1.38‐5.10) prognostic factor for postoperative bleeding. Even at multivariable analysis, increased PFLs were a significantly worse prognostic factor for post‐tonsillectomy haemorrhage (P = .016; HR 15.4; 95% CI 0.01‐0.6). High preoperative PFL was associated with significantly higher risk for post‐tonsillectomy haemorrhage within the first 31 days after surgery (65% vs 90%; P = .002). Moreover, accurate negative predictive value (NPV) of 95.1% pointed out that PFL could be used as a reliable preoperative screening marker. Conclusions Elevated PFL represents an independent worse prognostic factor for severe bleeding after tonsillectomy and could be helpful to identify patients at higher risk for PTH.

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“…40 We perform clotting profile on all cases for adenotonsillectomy as our regular routine pre-operatively and further group /cross match at least a unit of fresh whole blood before the procedure in the event of a need for transfusion despite the argument for and against. 41,42 Our dictum is 'any circumstance that has a chance of occurrence, can happen on any index case no matter how infinitesimally small: better to over prepare than under prepare'. For yet to be identified reasons, the right tonsil was found to be larger than the left in this cohort: right=12.5ml, mean 3.18±1.97 while left=11.0 ml, mean 2.96±1.55 ml similarly observed in a study.…”

Section: Discussionmentioning

confidence: 99%

Correlation between clinical grading of adenoid or tonsil hypertrophy and adenoid or tonsil volume post adenotonsillectomy: a prospective cohort study

Kokong

Adoga

Turaki

et al. 2020

Int J Otorhinolaryngol Head Neck Surg

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Background: Measuring adenoid or tonsil volume in surgically removed specimens is likely the most accurate method for quantifying adenotonsillar hypertrophy severity which may predict the extent of surgery to curtail post tonsillectomy haemorrhage a potential lethal complication.Methods: All patients with adenoid or tonsil hypertrophy were graded clinically while the objective grading by volumetric saline displacement in accordance with Archimedes’ principle; between August 1, 2017 to July 31, 2019 at the Jos University Teaching Hospital, Plateau State, Nigeria. Data analysis was by the SPSS version 21.0 Chicago IL, USA. Results: The study had 96 participants with a M:F=1.7:1. Age range was 9 months to 51 years, median was 3 yrs, mean was 9.5 yrs±15.5 yrs with 83 (86.5%) who were ≤18 yrs. Main features of this study, no. of patients in snoring was 83 (86.5%), nasal obstruction 71 (74.0%), rhinorrhoea 32 (33.3%), noisy breathing 23 (24.0%), dysphagia- 18 (18.8%), mouth breathing 18 (18.8%). Grading of this study was 78 (81.2%) were Brodsky grade III & IV while 72 (75.0%) had ANR of ≥0.5. Blood loss was range 10 ml to 250 ml, median 35 ml, mean 52.7±46.9 ml while 51 (63.0%) had blood loss of ≤50 ml. Volume of surgical specimen of adenoid; range 0.20-4.50 ml, mean 1.56±0.83 ml while tonsil; (Rt)-range 1.00-12.50 ml, mean 3.18±1.97 ml. There was a positive correlation between adenoid or tonsil grade and volume at 99% CI; (r)=0.409, (p=0.000) and grade (mean) 3.11±0.78, volume (mean) 3.18±1.96.Conclusions: This study establishes a positive correlation between clinical grading of adenoid or tonsil and volume with a certain level of accuracy which may predict extent of surgery to avoid post tonsillectomy hemorrhage, a life-threatening/lethal complication from excessive, partial or suboptimal surgery commonly.

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Risk of post-operative hemorrhage after adenoidectomy and tonsillectomy: Value of the preoperative determination of partial thromboplastin time and prothrombin time

Cited by 17 publications

References 14 publications

Unexpected, isolated activated partial thromboplastin time prolongation: A practical mini‐review

Unexpected, isolated activated partial thromboplastin time prolongation: A practical mini‐review

Preoperative plasma fibrinogen as a predictive factor for post‐tonsillectomy haemorrhage

Correlation between clinical grading of adenoid or tonsil hypertrophy and adenoid or tonsil volume post adenotonsillectomy: a prospective cohort study

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