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05:07
CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
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Perioperative management in chronically anticoagulated children undergoing tonsillectomy
Inbal Hazkani1,2, Kathleen R Billings1,2, Evan Edwards2
1Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Summary
Bridging therapy with unfractionated heparin (UFH) is effective for children on chronic anticoagulation undergoing tonsillectomy. This approach minimizes bleeding risk and ensures patient safety during the perioperative period.
Area of Science:
- Pediatric Surgery
- Cardiology
- Hematology
Background:
- Tonsillectomy in high-risk thrombotic patients on anticoagulation presents management challenges due to post-operative bleeding risk.
- Lack of evidence-based guidelines complicates perioperative anticoagulation strategies for these pediatric patients.
Purpose of the Study:
- To review perioperative anticoagulation bridging strategies in pediatric patients undergoing tonsillectomy.
Main Methods:
- Retrospective review of pediatric patients on chronic anticoagulation therapy undergoing tonsillectomy between 2010 and 2021.
- Inclusion criteria focused on high-risk patients requiring anticoagulation management.
Main Results:
- Four pediatric patients met inclusion criteria; all received intravenous unfractionated heparin (UFH) bridging pre-operatively.
- Minimal blood loss during surgery; UFH readministered post-operatively, with warfarin restarted within 2 days.
- Patients monitored until postoperative day 6-8; no significant bleeding events observed.
Conclusions:
- Perioperative bridging with UFH is a successful strategy for pediatric tonsillectomy patients on chronic anticoagulation.
- Multidisciplinary care is essential for managing the pre- and postoperative course of these high-risk patients.
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