Acetylsalicylic Acid, a Probable Cause for Secondary Post-Tonsillectomy Hemorrhage: A Preliminary Report

Abstract

The post-tonsillectomy healing process is characterized by a reactive inflammation with healing by second intention. As a clinical complication, bleeding, sometimes of a dangerous nature, may occur. This postoperative hemorrhage is classified as either primary or secondary. The former, rarely encountered, arises within the first twenty-four hours after operation and originates from a small spurting artery or a small oozing vein; the latter occurs three to ten days postoperatively and is of the parenchymatous type. Thus, apart from those infrequent cases complicated by primary hemorrhage, two types of postoperative course may be observed: (a) the normal process of healing with reactive inflammation of a nonhemorrhagic nature, in which secondary hemorrhage does not occur, and (b) the abnormal process, exhibiting a characteristic hemorrhagic inflammation of the soft palate and often complicated by secondary hemorrhage. The nature of the postoperative course is not influenced by the surgical method of removal, the type of anesthesia employed or the age or the sex of the patient.In the normal postoperative course, the fossae stay dry and, after eight to sixteen hours, become covered with a fibrinous membrane which, after one day, spreads over the entire wound, the margins of which have an inflammatory appearance.Occasionally the uvula becomes edematous. Pain increases during the first day and tends to abate on the second, but may become worse on the morning of the third day with some radiation into the ears before completely subsiding. On about the sixth postoperative day, the sloughing of the membranes commences, and the size of the wounds diminishes quite rapidly as the fossae appear lined with granulation tissue, often exhibiting a secondary and thinner membrane.If the healing process is abnormal, the postoperative course of the first two days follows the same pattern as during the initial stage of the first type. However, on the third day a hemorrhagic inflammatory suffusion of the wound margins develops which, unaccompanied by pain, quickly progresses into the soft palate and the uvula. The margins of this suffusion are sharply defined and angular, seldom extend¬ ing beyond the soft palate, and the membranescovering the fossae have a dirty gray appear¬ ance.

Effect of Acetylsalicylic Acid, Paracetamol and Placebo on Pain and Blood Loss in Dysmenorrheic Women

“…Acetylsalicylic acid may cause excessive bleeding during and after surgery (9,20,22), it may promote epistaxis (17), and haemorrhagic complications seem to be more frequent in the newborn infants of women who have ingested acetylsalicylic acid during the last week of pregqancy (4). The effects of the drug o n haemostasis are multiple.…”

Resistencia a la aspirina: un problema latente de alto riesgo

“…Podría asumirse que el camino al uso de la aspirina como antiagregante plaquetario se inició desde 1945, cuando en la literatura médica mundial se informó, una vez más, el riesgo hemorrágico por el consumo de la aspirina [30][31][32], especialmente, cuando se empezó a observar en pacientes sometidos a amigdalectomía [33], a quienes se les practicaban extracciones dentales [34] y a nivel gastrointestinal [35]. Inicialmente, las manifestaciones hemorrágicas fueron erróneamente atribuidas a una alteración en el tiempo de protrombina [36], hasta 1948, cuando Paul Gibson, en Inglaterra, sugirió que el ácido acetilsalicílico podría ser útil en el tratamiento de la trombosis coronaria [37] y al año siguiente presentó informes de casos que detallaban el papel de la aspirina en el tratamiento de la trombosis coronaria y de la angina de pecho [38].…”

Clinical Pharmacology of Acetylsalicylic Acid

“…Clinically, this can result in easy bruisability in patients taking aspirin or aspirin-containing products, as well as significant bleeding following minor or major surgical procedures. Its use has been implicated as a probable cause of post-tonsillectomy hemorrhage and bleeding following tooth extractions [89]. The effect on hemostasis may be disproportionately greater in patients with bleeding disorders such as hemophilia, von Willebrand's disease or afibrinogenemia [90].…”