Coagulation disorders do not increase the risk for bleeding during percutaneous dilatational tracheotomy.
BACKGROUND
Percutaneous dilatational tracheotomy (PDT) is a common procedure. Coagulation disorders represent a relative contraindication for PDT and, therefore, normalization of hemostasis parameters is recommended. Especially patients undergoing cardiac surgery after valve replacement and with any kind of assist device need to require an adequate anticoagulation. This study investigated the impact of impaired hemostasis as a risk factor for bleeding complications retrospectively.


METHODS
Patients who underwent PDT (November 2007 to November 2010) were stratified into a high-risk (HR) and low-risk (LR) group in regard to bleeding complications. The following determining factors activated partial thromboplastin time (aPTT > 50 seconds, prothrombin time (PT < 50%), international normalized ratio (INR > 1.4), and platelet count (< 50,000/µL) were assessed.


RESULTS
A total of 213 patients underwent PDT (HR = 5/85; LR = 8/128). There was no difference in demographics or intraoperative data. Patients of both groups showed mild bleeding without the need for surgical intervention or transfusion (p = 0.957). There were no severe bleeding nor other procedure-related complications.


CONCLUSIONS
Percutaneous tracheotomy is a safe and feasible procedure in patients with coagulation disorders. Therefore, discontinuation of anticoagulation treatment or normalization of hemostasis prior to the procedure is not necessary.
Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
Antje-Christin
AC
Deppe
Elmar
E
Kuhn
Maximilian
M
Scherner
Ingo
I
Slottosch
Oliver
O
Liakopoulos
Georg
G
Langebartels
Yeong-Hoon
YH
Choi
Thorsten
T
Wahlers
D000368:Aged; D001777:Blood Coagulation; D001778:Blood Coagulation Disorders / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D004106:Dilatation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D010314:Partial Thromboplastin Time; D011379:Prognosis; D011517:Prothrombin Time; D012131:Respiratory Insufficiency / Q000097:blood / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D014140:Tracheotomy / Q000009:adverse effects* / Q000379:methods