Asaf T, Reuveni H, Yermiahu T, Leiberman A, Gurman G, Porat A, Schlaeffer P, Shifra S, Kapelushnik J
Pediatric Hemato-Oncology Unit, Soroka University Medical Center, P.O. Box 151, Beer-Sheva 84101, Israel.
Int J Pediatr Otorhinolaryngol. 2001 Dec 1;61(3):217-22. doi: 10.1016/s0165-5876(01)00574-2.
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.
在一些医疗中心，对计划接受扁桃体切除术和/或腺样体切除术（T&A）的健康儿童进行的常规术前评估包括凝血筛查试验（PT，凝血酶原时间；PTT，部分凝血活酶时间；INR，国际标准化比值）。在这项回顾性研究中，我们确定了在无凝血问题既往病史的健康儿童中，PT/PTT/INR试验延长与手术期间出血和/或术后一个月内出血之间是否存在正相关。我们回顾了1999年期间在以色列贝尔谢巴的索罗卡大学医学中心进行的416例择期T&A手术的记录。121例（29.1%）患者术前PT值延长，但这些患者中只有4例（3.3%）在手术期间出现轻度出血。121例PT试验延长的患者中有7例（5.8%）在术后第一个月出现出血事件。在65例（15.6%）术前INR值延长的患者中，只有3例（4.6%）在手术期间出现轻度出血。2例（3.1%）INR值延长的患者在术后第一个月出现轻度出血。61例（14.7%）患者术前首次PTT值延长，其中只有5例（8.2%）在手术期间出现轻度出血。61例PTT值延长的患者中有2例（3.3%）在术后第一个月出现轻度出血。因此，我们得出结论，术前凝血筛查试验的敏感性和出血预测价值较低。因此，除非怀疑有出血倾向病史，否则不建议在T&A术前进行常规凝血试验。
