Characteristics of Children Diagnosed as Having Coagulopathies Following Posttonsillectomy Bleeding

Sun, Gordon H.; Harmych, Brian M.; Dickson, J. Matthew; Rey, Javier A. Gonzalez del; Myer, Charles M.; Greinwald, John H.

doi:10.1001/archoto.2010.227

Cited by 10 publications

(6 citation statements)

References 12 publications

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“…The goal in both adult and pediatric cases is better life quality. [1][2][3][4][5][6][7] Complications of surgery in this situation are pain, feeling nauseous or actual vomiting, fluid loss and hemorrhage. [8,9] Post-tonsillectomy hemorrhage (PTH) numbers amongst the gravest consequences of tonsillectomy.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors For Post-Tonsillectomy Hemorrhage

Susaman¹,

Kaygusuz²,

Karlıdağ³

et al. 2018

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Objectives: This research was undertaken to determine the frequency of post-tonsillectomy hemorrhage (PTH) in one particular clinical setting and to assess which risk factors exist for PTH. Methods: Following a retrospective case review of 892 patients who had gone through either tonsillectomy or adenotonsillectomy, a subgroup of 50 records were selected for detailed study. These 50 patients were then classified as either pediatric cases (aged under 16) or adult cases (aged over 16). Their risk factors were then assessed. Risk factors included: age, sex, surgical indication; type of surgery; time hospitalized post-operatively; timing of PTH (primary and secondary); management used to staunch bleeding and time in hospital following PTH. Results: The overall rate of PTH was 5.6% (3.0% pediatric, 2.6% adult). All PTH instances were secondary and no primary type occurred. In comparing the adult and pediatric cases of PTH, there was no statistically significant difference (p>0.05) in terms of age, sex, time hospitalized post-operatively, management used to staunch bleeding or time in hospital following PTH. There was, however, a statistically significant difference (p<0.05) between groups in terms of surgical indication and timing of PTH (primary or secondary). Conclusion: There was an increased frequency of secondary PTH in both groups. PTH typically happened between day 5 and 10 post-operatively. Patients need to be advised about this risk and show caution regarding factors that increase the risk of PTH after surgery.

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Section: Introductionmentioning

confidence: 99%

Risk Factors For Post-Tonsillectomy Hemorrhage

Susaman¹,

Kaygusuz²,

Karlıdağ³

et al. 2018

ENT Updates

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“…The authors concluded that children should have aPTT and PFA testing as part of their initial workup and referrals to hematology after PTH were useful. 18 Conversely, a series of 93 secondary hemorrhages could not identify any significant clotting abnormalities and suggested that such testing should not be undertaken routinely unless clinical suspicion is warranted. 19 Consequently, many clinicians consider PT or aPTT to be relatively insensitive to detect vWD or hemophilia with poor cost-effectiveness.…”

Section: Discussionmentioning

confidence: 99%

“…In a previous review, children presenting with PTH had significant differences in aPTT and platelet function assay (PFA). The authors concluded that children should have aPTT and PFA testing as part of their initial workup and referrals to hematology after PTH were useful 18 . Conversely, a series of 93 secondary hemorrhages could not identify any significant clotting abnormalities and suggested that such testing should not be undertaken routinely unless clinical suspicion is warranted 19 .…”

Section: Discussionmentioning

confidence: 99%

Post‐Tonsillectomy Hemorrhage and the Diagnosis of Occult Pediatric Coagulopathies

et al. 2020

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Objectives/Hypothesis: The primary objective of this investigation was to determine rates of abnormal coagulation panels and diagnoses of coagulopathies in children with post-tonsillectomy hemorrhage (PTH). Secondary objectives identified patient demographics and hemorrhage event characteristics that correlated with a coagulopathy diagnosis.Study Design: Case series with chart review. Methods: Patients requiring operative control of PTH at a tertiary children's hospital between 2015 and 2019 were included. Details of tonsillectomy procedures and hemorrhage events were reviewed along with screening labs for coagulopathy, referrals to hematology and bleeding disorder diagnoses.Results: There were 250 children included. Mean age was 8.8 years (95% CI: 8.2-9.4) and 53.6% were males. PTH events occurred at a median of postoperative day six (mean: 5.9, 95% CI: 5.4-6.3), and 14.8% occurred within 24 hours of surgery. In this series, 23 patients (9.2%) had a second PTH, and three (1.2%) had a third PTH. Single and multiple PTH patients were similar with respect to age, gender, postoperative day, and technique (P > .05). Screening coagulation panels were obtained on presentation in 67.8% of children with one PTH and abnormally elevated in 38.3%. All children with multiple PTHs had labs drawn with 34.8% having elevated levels. No child with a single PTH was diagnosed with a bleeding disorder. Conversely, 87.0% of children with multiple PTHs saw hematology and three (13.0%) were diagnosed with a bleeding disorder (P < .001).Conclusions: Obtaining coagulation panels in pediatric patients presenting with PTH is rarely useful and diagnosing a coagulopathy is uncommon. However, among children with a second PTH, referral to hematology is reasonable as this group has a significantly higher, albeit small, incidence of undiagnosed bleeding disorders.

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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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Characteristics of Children Diagnosed as Having Coagulopathies Following Posttonsillectomy Bleeding

Cited by 10 publications

References 12 publications

Risk Factors For Post-Tonsillectomy Hemorrhage

Risk Factors For Post-Tonsillectomy Hemorrhage

Post‐Tonsillectomy Hemorrhage and the Diagnosis of Occult Pediatric Coagulopathies

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

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