title: Value of preoperative prothrombin time/partial thromboplastin time as a predictor of postoperative hemorrhage in pediatric patients undergoing tonsillectomy.
abstract: OBJECTIVE
  Hemorrhage after tonsillectomy is a potentially lethal complication. Preoperative assessment consisting of prothrombin time (PT) and activated partial thromboplastin time (PTT) has been used to identify patients at risk for hemorrhage after tonsillectomy and adenoidectomy. We sought to assess the value of PT/PTT screening as a predictor of posttonsillectomy hemorrhage.
  
  
  METHODS
  A retrospective chart review was carried out with a minimum of 1 month follow-up.
  
  
  METHODS
  Tertiary academic referral center.
  
  
  METHODS
  Between January 1992 and June 1995, 382 patients undergoing tonsillectomy were examined; 339 patients with a minimum of 1 month follow-up were reviewed for this study.
  
  
  METHODS
  Normal and prolonged PT/PTT values were examined. Bleeding in the intraoperative, immediate postoperative, and delayed phases of healing was examined.
  
  
  RESULTS
  Two-hundred and twenty-two patients had normal PT/PTT, 39 had prolonged PT/PTT, and 78 had no preoperative studies performed. Bleeding occurred in 2.7%, 2.6%, and 3.3%, respectively, of patients. Eight patients had positive family histories of bleeding tendencies. One patient (12.5%) with a normal PT/PTT experienced a delayed posttonsillectomy bleed. Of 39 patients with abnormal coagulation studies, 30 were borderline elevations with no repeat studies done; one patient experienced postoperative hemorrhage. Nine abnormal results were repeated; three returned to normal, three remained prolonged but underwent tonsillectomy with no intervention, and three received hematology consultations. One patient had lupus anticoagulant, one 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 pediatric population undergoing tonsillectomy. This should only be done in selective cases where warranted by history.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown 26506, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Howells
authors.forename: M K
authors.initials: MK
authors.lastname: Wax
authors.forename: H H
authors.initials: HH
authors.lastname: Ramadan
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010314:Partial Thromboplastin Time; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000097:blood* / Q000175:diagnosis; D011517:Prothrombin Time; D012189:Retrospective Studies; D012307:Risk Factors; D014068:Tonsillectomy