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The need for routine pre-operative coagulation screening tests (prothrombin time PT/partial thromboplastin time PTT)
T Asaf1, H Reuveni, T Yermiahu
1Pediatric Hemato-Oncology Unit, Soroka University Medical Center, P.O. Box 151, Beer-Sheva 84101, Israel.
Insights
Routine pre-operative coagulation screening tests for healthy children undergoing tonsillectomy and/or adenoidectomy (T and A) show low predictive value for bleeding. These tests are not recommended unless a patient has a history of bleeding issues.
Area of Science:
- Pediatric Surgery
- Hematology
- Anesthesiology
Background:
- Pre-operative coagulation screening tests (PT, PTT, INR) are routinely performed for healthy children before elective tonsillectomy and/or adenoidectomy (T and A).
- The utility of these tests in predicting surgical or post-operative bleeding in this population is uncertain.
Purpose of the Study:
- To determine the correlation between prolonged pre-operative coagulation test results (PT, PTT, INR) and intraoperative or post-operative bleeding in healthy children undergoing T and A.
Main Methods:
- Retrospective review of 416 elective T and A surgeries at Soroka University Medical Center in 1999.
- Analysis of pre-operative PT, PTT, and INR values in relation to bleeding events during surgery and within one month post-surgery.
Main Results:
- Prolonged PT (29.1%), INR (15.6%), and PTT (14.7%) were observed in a significant proportion of patients.
- However, the incidence of intraoperative or post-operative bleeding was low (3.1%–8.2%) across all prolonged test groups.
- Low sensitivity and predictive value were found for these coagulation tests.
Conclusions:
- Pre-operative coagulation screening tests have low sensitivity and predictive value for bleeding in healthy children undergoing T and A.
- Routine coagulation testing is not indicated for these procedures unless a personal or family history of bleeding disorders is present.
Abstract:
In some medical centers, the routine pre-operative evaluation of healthy children undergoing elective tonsillectomy and/or adenoidectomy (T and A) includes coagulation screening tests (PT, prothrombin Time; PTT, partial thromboplastin time; and INR, international normalized ratio). In this retrospective study, we determined whether there is a positive correlation between prolonged PT/PTT/INR tests in healthy children, with no prior medical history of coagulation problems, and bleeding during surgery and/or bleeding in the month following surgery. We reviewed the records of 416 elective T and A surgeries performed at the Soroka University Medical Center in Beer-Sheva, Israel, over the course of 1999. One hundred and twenty-one (29.1%) patients had preoperative prolonged PT values but only four (3.3%) of these patients experienced light bleeding during surgery. Seven (5.8%) of the 121 patients with prolonged PT tests experienced bleeding episodes during the 1st month subsequent to the surgery. Of the 65 (15.6%) patients who had prolonged pre-operative INR values, only three (4.6%) experienced light bleeding during surgery. Two (3.1%) patients with prolonged INR values experienced light bleeding during the 1st month subsequent to surgery. Sixty-one (14.7%) patients had prolonged first preoperative PTT values, only five of whom (8.2%) experienced light bleeding during surgery. Two (3.3%) of the 61 with prolonged PTT values experienced light bleeding during the 1st month subsequent to surgery. We therefore concluded that pre-operative coagulation screening tests provide low sensitivity and low bleeding predictive value. As such, routine coagulation tests before T &A are not indicated unless a medical history of bleeding tendency is suspected.
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