Screening for undiagnosed bleeding disorders in post-tonsillectomy bleed patients: Retrospective review and systematic review of the literature

Gitomer, Sarah A.; Anand, Grace Shebha; Bradley, Hallie E.; Kumar, Manish; Ouellette, Lara; Musso, Mary Frances

doi:10.1016/j.ijporl.2019.06.009

Cited by 12 publications

(10 citation statements)

References 29 publications

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“…Gitomer and colleagues reviewed over 12,000 tonsillectomies and reported that only 2% of the 311 children with PTH were diagnosed with a coagulopathy. 10 Another study evaluating 250 PTHs identified a higher likelihood of an underlying coagulopathy in children with multiple PTH. Interestingly 38% of patients with one PTH had abnormal PT/PTT but none were diagnosed with a coagulopathy.…”

Section: Underlying Coagulopathymentioning

confidence: 99%

Adenotonsillectomy in high risk patients: Hematologic abnormalities and COVID‐19 considerations

Ruiz

Dedhia

2021

World j. otorhinolaryngol.-head neck surg.

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Adenotonsillectomy is one of the most common surgical procedures performed by otolaryngologists. It is vital that surgeons are aware of the risks in performing this surgery especially during the COVID-19 pandemic and in children with hematologic disorders. In this review we describe common hematologic disorders often noted in pediatric patients undergoing this procedure, as well as proper screening and management of these patients. In addition, we also address the impact of the COVID-19 pandemic and some measures to help mitigate the risks of this procedure during this time.

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Section: Underlying Coagulopathymentioning

confidence: 99%

Adenotonsillectomy in high risk patients: Hematologic abnormalities and COVID‐19 considerations

Ruiz

Dedhia

2021

World j. otorhinolaryngol.-head neck surg.

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“…Some studies conclude that patients with diagnosed BDs do not have an increased risk of PTB, and some suggest that appropriate pre‐surgical treatment mitigates PTB's risk. 10 , 11 , 12 Others indicate that the risk of secondary PTB, defined by PTB after the first 24 postoperative hours, increases in this subset of patients with PTB rates around 8.7%‐15.5%. 9 , 13 , 14 Although more research is needed to determine the true risk of PTB in patients with BDs, it is still imperative for children undergoing T/A procedures to obtain pretreatment medications to prevent potentially life‐threatening bleeds.…”

Section: Introductionmentioning

confidence: 99%

“…PTB in patients with BDs is a controversial topic in the current literature. Some studies conclude that patients with diagnosed BDs do not have an increased risk of PTB, and some suggest that appropriate pre‐surgical treatment mitigates PTB's risk 10‐12 . Others indicate that the risk of secondary PTB, defined by PTB after the first 24 postoperative hours, increases in this subset of patients with PTB rates around 8.7%‐15.5% 9,13,14 .…”

Section: Introductionmentioning

confidence: 99%

Postoperative tonsil/adenoidectomy bleeding management in patients with diagnosed bleeding disorders

Pai

Desai

Stein

et al. 2021

Laryngoscope Investig Oto

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Objective Tonsil/adenoidectomy (T/A) is a commonly performed procedure with an average post‐tonsillectomy bleed (PTB) rate between 3 and 5%. Patients with bleeding disorders (BDs) are believed to have an increased risk of PTB. We hypothesize that our medical management of BD patients using a combination of DDAVP/antifibrinolytic agents has a similar PTB rate to control patients. This study suggests a standardized protocol for patients with BDs to avoid PTB. Methods A retrospective cohort study was completed for patients with BD who underwent tonsillectomy or T/A at Promedica Toledo or Flower Hospital between 2013 and 2020. Exclusion criteria included incomplete records, diagnosis of BD after surgery, and inability to find age and sex matched control. We defined the control group as patients who underwent T/A without BD. The following variables were collected: age, sex, medical history, BD severity, medications, type of surgery, indication for surgery, estimated blood loss (EBL), pre/postoperative medications, PTB status, and post‐PTB intervention. Results A total of 164 patient charts were reviewed. There were 82 patients in both cohorts. The BDs represented were platelet function disorder (80.5%), von Willebrand disease (14.6%), and others such as Factor VII and IX deficiency (4.9%). Of the BD patients included, 13.4% had severe disease. There was no significant difference between the age, sex, EBL, and PTB rates. Of the 8 BD patients with PTB, 62% bled 9‐10 days postoperatively and none had severe disease. Conclusion Our protocol to prevent PTB in patients with BDs produced similar bleed rates to control patients in this study. Further studies are required to assess postoperative length of antifibrinolytic treatment in BD patients. Level of Evidence III.

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“…During or after a surgical procedure, bleeding manifests as either minor oozing that may last for up to 24 hours or PB that may result in serious consequences and which may even be life threatening (Cuccia and Geraci, 2019;Kriwalsky et al, 2014;Varvara et al, 2019). Patients who are at risk of PB during or after surgical interventions encompass individuals with hematological disorders such as hemophilia and Von Willebrand disease (Gitomer et al, 2019;Rodriguez-Merchan, 2019). Likewise, patients using fibrinolytic medications (or anticoagulants such as acetylsalicylic acid and warfarin) for the treatment of cardiovascular disorders (CVD) are also vulnerable to PB during or after surgical interventions.…”

Section: Introductionmentioning

confidence: 99%

Assessment of routine diet (garlic consumption) as a pre- and postoperative protocol in oral and maxillofacial surgical interventions: An evidence-based literature review

et al. 2020

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Background: It was hypothesized that pathological bleeding (PB) during and/or after oral surgical procedures is higher in systemically healthy patients who have a history of garlic intake compared to controls (patients without a history of garlic consumption). Aim: The aim of the present review article was to identify studies in which garlic consumption was included as a patient management protocol before and after oral and maxillofacial surgery (OMFS). Methods: A review of pertinent indexed literature was performed. The focused question that was addressed was “Has diet (garlic consumption) been considered as a patient management protocol before and after OMFS?” The inclusion criteria were: (a) studies published in indexed databases, (b) original studies, (c) studies on OMFS, and (d) studies that considered diet (garlic consumption) as a patient management protocol before and after OMFS. Literature review, commentaries, letters to the editor, and studies published in non-indexed resources were excluded. The pattern of the present review was customized to summarize the pertinent information. Results: The initial search using the terms “oral,” maxillofacial,” “protocol,” and “surgery” yielded 1478 studies. The addition of the term “diet” to this search strategy reduced the number of studies to five. Further filtration of these studies using the terms “garlic” and/or “ Allium sativum” showed no studies. Conclusions: Garlic intake predisposes patients to PB. However, there are no studies in the indexed literature that have considered the inclusion of garlic consumption in patient management protocols before and after OMFS.

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Screening for undiagnosed bleeding disorders in post-tonsillectomy bleed patients: Retrospective review and systematic review of the literature

Cited by 12 publications

References 29 publications

Adenotonsillectomy in high risk patients: Hematologic abnormalities and COVID‐19 considerations

Adenotonsillectomy in high risk patients: Hematologic abnormalities and COVID‐19 considerations

Postoperative tonsil/adenoidectomy bleeding management in patients with diagnosed bleeding disorders

Assessment of routine diet (garlic consumption) as a pre- and postoperative protocol in oral and maxillofacial surgical interventions: An evidence-based literature review

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