VALUE OF PREOPERATIVE PROTHROMBIN TIME PARTIAL THROMBOPLASTIN TIME ASA PREDICTOR OF POSTOPERATIVE HEMORRHAGE IN PEDIATRIC-PATIENTS UNDERGOING TONSILLECTOMY

OBJECTIVE: Hemorrhage after tonsillectomy is a potentially lethal comp lication. Preoperative assessment consisting of prothrombin time (PT) and activated partial thromboplastin time (PTT) has been used to ident ify patients at risk for hemorrhage after tonsillectomy and adenoidect omy. We sought to assess the value of PT/PTT screening as a predictor of posttonsillectomy hemorrhage. DESIGN: A retrospective chart review was carried out with a minimum of 1 month follow-up. SETTING: Tertiary academic referral center. PATIENTS: Between January 1992 and June 199 5, 382 patients undergoing tonsillectomy were examined; 339 patients w ith a minimum of 1 month follow-up were reviewed for this study. MAIN OUTCOME MEASURE: Normal and prolonged PT/PTT Values were examined. Ble eding in the intraoperative, immediate postoperative, and delayed phas es of healing was examined. RESULTS:Two-hundred and twenty-two patient s had normal PT/PTT, 39 had prolonged PT/PTT, and 78 had no preoperati ve studies performed. Bleeding occurred in 2.7%, 2.6%, and 3.3%, respe ctively, of patients. Eight patients had positive family histories of bleeding tendencies. One patient (12.5%) with a normal PT/PTT experien ced a delayed posttonsillectomy bleed. Of 39 patients with abnormal co agulation studies, 30 were borderline elevations with no repeat studie s done; one patient experienced postoperative hemorrhage. Nine abnorma l results were repeated; three returned to normal, three remained prol onged but underwent tonsillectomy with no intervention, and three rece ived hematology consultations. One patient had lupus anticoagulant, on e had Hageman Factor deficiency, and one was cleared for surgery with no diagnosis. All patients underwent tonsillectomy with no episodes of postoperative bleeding. CONCLUSIONS: Preoperative PT/PTT provides no additional information than does a bleeding history for the general pe diatric population undergoing tonsillectomy. This should only be done in selective cases Where warranted by history.