Contributions
Abstract: PB1805
Type: Publication Only
Background
In spite of guidelines recommending the no need for coagulation profile prior to ENT surgeries when challenging history of bleeding is negative, yet surgeons still practice it. Cost and delaying surgeries are major issues faced when insignificant abnormalities are found in the coagulation profile results. In 2008, British Committee for Standards of Hematology has published guidelines (1) on assessing the bleeding risk prior to surgeries or invasive procedures, which stated that the indication for sending a coagulation profile is based on the bleeding history of the patient.
Aims
This study aims to identify the reasons of ENT surgeons for requesting pre-operative coagulation screening; prothrombin time (PT) and activated partial thromboplastin time (APTT) in spite of the available evidence and guidelines of their poor correlation with bleeding risk.
Methods
The current work was based on a survey conducted at 3 tertiary care facilities in the Sultanate of Oman for surgeons who performed adenoidectomy/adeno-tonsillectomy and other ENT surgical procedures during the period from 1st Jan 2017 to 1st September 2017. The Survey was conducted for identifying the practice of the ENT surgeons prior to surgeries, either getting a challenging bleeding history from the patients/guardians or requesting a coagulation profile (PT, APTT) as well. Surgeons who decide to do coagulation profile were requested to identify their reason. Patients with proven or suspected bleeding disorder (based on the past and family history) were excluded.
Results
The study included data from 730 patients who underwent ENT surgical procedures. They were 432 males and 298 females. Their mean age was 19.6 + 16.92 year. Out the 730 patients, 372 patients were interviewed for a challenging bleeding history alone (group 1) and 358 were interviewed plus a pre-operative coagulation profile check (Group 2). Two patients had an intraoperative minor bleed that requires stitching (one in each group). Three patients in group 2 had post-operative secondary bleeding after 1 week that responded to local hemostatic measures. Twenty eight surgeons who preferred to do the coagulation profile for their patients answered the survey. Twenty two (78.5%) gave the reason of habitual practice and overprotection, 4 were not confident with the current evidence and 2 had previous bleeding experience with their patients.
Conclusion
Despite the current evidence of meta-analysis and the hospital guidelines, still many surgeons prefer to do coagulation check before ENT surgeries for different reasons. Surgeons need to be educated more on the current evidence of the superiority of the challenging bleeding history over the routine PT and APTT tests. This might reduce the waiting time for performing these procedures.
Reference:
- Chee YL1, Crawford JC, Watson HG, Greaves M. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Committee for Standards in Haematology. Br J Haematol. 2008 Mar;140(5):496-504.
Session topic: 34. Bleeding disorders (congenital and acquired)
Keyword(s): APTT, Bleeding, Risk factor, Surgery
Abstract: PB1805
Type: Publication Only
Background
In spite of guidelines recommending the no need for coagulation profile prior to ENT surgeries when challenging history of bleeding is negative, yet surgeons still practice it. Cost and delaying surgeries are major issues faced when insignificant abnormalities are found in the coagulation profile results. In 2008, British Committee for Standards of Hematology has published guidelines (1) on assessing the bleeding risk prior to surgeries or invasive procedures, which stated that the indication for sending a coagulation profile is based on the bleeding history of the patient.
Aims
This study aims to identify the reasons of ENT surgeons for requesting pre-operative coagulation screening; prothrombin time (PT) and activated partial thromboplastin time (APTT) in spite of the available evidence and guidelines of their poor correlation with bleeding risk.
Methods
The current work was based on a survey conducted at 3 tertiary care facilities in the Sultanate of Oman for surgeons who performed adenoidectomy/adeno-tonsillectomy and other ENT surgical procedures during the period from 1st Jan 2017 to 1st September 2017. The Survey was conducted for identifying the practice of the ENT surgeons prior to surgeries, either getting a challenging bleeding history from the patients/guardians or requesting a coagulation profile (PT, APTT) as well. Surgeons who decide to do coagulation profile were requested to identify their reason. Patients with proven or suspected bleeding disorder (based on the past and family history) were excluded.
Results
The study included data from 730 patients who underwent ENT surgical procedures. They were 432 males and 298 females. Their mean age was 19.6 + 16.92 year. Out the 730 patients, 372 patients were interviewed for a challenging bleeding history alone (group 1) and 358 were interviewed plus a pre-operative coagulation profile check (Group 2). Two patients had an intraoperative minor bleed that requires stitching (one in each group). Three patients in group 2 had post-operative secondary bleeding after 1 week that responded to local hemostatic measures. Twenty eight surgeons who preferred to do the coagulation profile for their patients answered the survey. Twenty two (78.5%) gave the reason of habitual practice and overprotection, 4 were not confident with the current evidence and 2 had previous bleeding experience with their patients.
Conclusion
Despite the current evidence of meta-analysis and the hospital guidelines, still many surgeons prefer to do coagulation check before ENT surgeries for different reasons. Surgeons need to be educated more on the current evidence of the superiority of the challenging bleeding history over the routine PT and APTT tests. This might reduce the waiting time for performing these procedures.
Reference:
- Chee YL1, Crawford JC, Watson HG, Greaves M. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Committee for Standards in Haematology. Br J Haematol. 2008 Mar;140(5):496-504.
Session topic: 34. Bleeding disorders (congenital and acquired)
Keyword(s): APTT, Bleeding, Risk factor, Surgery