Coagulation history ‘should be taken before tonsillectomy’

By Joesphine McCoan

Adults scheduled for tonsillectomy should be asked about their coagulation history before the procedure, researchers warn.

Patients who have experienced a prior episode of coagulopathy are twice as likely as others to experience a hemorrhage, report Stephanie Sarny and colleagues from the Department of General Oto-Rhino-Laryngology at the Medical University of Graz in Austria.

This was the finding of their study of 3041 adults who underwent tonsillectomy.

Until now, removal of the tonsils has been widely considered to be "safe surgeries with low complication rates," and postoperative hemorrhage to be the worst complication, Sarny et al note.

Ongoing discussion about possible risk factors for postoperative hemorrhage increased following the deaths of five children younger than 6 years of age. A particular strand of investigation has become whether pre-existing bleeding disorders might contribute to this risk.

To investigate further, Sarny and team performed preoperative laboratory screening for coagulopathy in the participants of the current study and assessment of whether or not they had a history of coagulopathy. The participants were then followed up for evidence of postoperative hemorrhage for 9 months. Postoperative bleeding was defined as any bleeding episode after extubation.

The investigators found that, in line with previous research, 16% of the patients experienced postoperative hemorrhage, including the patients in whom bleeding occurred after extubation.

Overall, just 55 (2%) of 2998 participants assessed had a history of coagulopathy. The likelihood for postoperative hemorrhage was significantly higher among these patients, at 31%, compared with 16% of patients without a history of coagulopathy.

By contrast, positive laboratory screening for coagulopathy did not predict the risk for postoperative hemorrhage, occurring in a similar number of patients with and those without a postoperative bleed, at 20% of 94 and 16% of 2249, respectively.

"A positive history if coagulopathy should be taken in adults prior to tonsillectomy as in our study every third patient with a positive history of coagulopathy experienced a postoperative bleeding episode," write Sarny et al in the European Archives of Oto-Rhino-Laryngology.

"Laboratory screening for coagulopathy prior to tonsillectomy in adults does not predict postoperative bleeding episode and its routine performance is not recommended," they continue.

In conclusion, the investigators recommend that a standardized questionnaire be developed to assess patients' family history of coagulopathy before the decision is made to perform tonsillectomy.

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