Post-tonsillectomy haemorrhage Do coagulation tests and coagulopathy history have predictive value?

Objectives: Determining post-tonsillectomy haemorrhage (PTH) risk factors is crucial for preventing it. The aim of the study was to analyse results of coagulation tests and preoperative family and medical history of coagulation disorders in order to establish if they have predictive value for PTH. Methods: In 222 patients aged 15-60 years, values of APTT (Activated Partial Thromboplastin Time), prothrombin/INR ratio and platelet count as well as medical history were analysed and 15 episodes of secondary PTH occurred. This includes 3 of 9 (33.3%) patients with medical history of proneness to bruises after minor trauma and in all (4) patients who declared both relevant medical history of proneness to bruise formation after minor trauma and proneness to prolonged bleeding after injury. Results: Five individuals had elevated APTT values and proneness to bruise formation after minor trauma, and other six patients had elevated APTT values, relevant history of frequent epistaxis and family coagulation disorders. In none of these patients PTH occurred. There was one episode of primary and no secondary PTH in 15 patients with values of APTT elevated <= 10% of the normal value. No PTH occurred in 6 individuals with APTT elevated by > 10% of the normal value. Haemorrhage rate correlated with APTT results, proneness to bruise formation and to bleeding after injuries. Values of specificity of recurrent epistaxis, history of bruises after minor trauma and prolonged bleeding after injury were significant. Conclusions: In healthy adults, coagulation tests results are irrelevant for the course of tonsillectomy and postoperative bleeding event. Personal medical history is important in predicting PTH. (C) 2009 Elsevier Espana, S.L. All rights reserved.