HEMOSTATIC ASSESSMENT OF PATIENTS BEFORE TONSILLECTOMY - A PROSPECTIVE-STUDY

The purpose of this prospective study in patients undergoing tonsillec tomy was to determine whether perioperative bleeding could be predicte d by use of a standardized questionnaire concerning bleeding risk comb ined with measurement of the activated partial thromboplastin time and prothrombin time. Of the 96 patients enrolled in the study, none had a history of a severe bleeding disorder, but 6 (6%) had histories sugg estive of a mild bleeding disorder. Further evaluation showed possible van Willebrand's disease in one of these patients. Of the 90 patients with negative questionnaires, 16% had prolongation of the activated p artial thromboplastin time. One of these patients had possible von Wil lebrand's disease. However, none of the patients with positive questio nnaires or a prolonged activated partial thromboplastin time bled afte r surgery. Bleeding that resulted in additional hospital use occurred in 2% of patients, and blood-tinged sputum was described by 4% after d ischarge; all of these patients had negative questionnaires and normal screening studies. The data provide further evidence that routine mea surement of the activated partial thromboplastin time and prothrombin time in asymptomatic patients is not useful for predicting postoperati ve bleeding. In addition, histories suggestive of a mild bleeding diso rder are also not accurate predictors of postoperative bleeding. Exces sive bleeding associated with tonsillectomy is usually not a result of an identifiable coagulation disorder.