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ISSN 2594-1518 (Electronic)
ISSN 1405-0099 (Print)

2018, Number 3

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Cir Gen 2018; 40 (3)

Routine coagulation tests during elective abdominal surgery to predict the risk of bleeding

Romero-González RJ, Ruiz-Flores C, Galindo-Lagunes D

Language: Spanish
References: 20
Page: 169-174
PDF size: 224.99 Kb.


ABSTRACT

Introduction: Many hospitals in Mexico perform routine coagulation tests prior to an elective surgery to prevent intra- or postoperative bleeding. However, in the surgical literature, some authors do not approve this practice. Objective: To analyze the utility of coagulation tests for elective surgeries and the possibility for intra or postoperative bleeding. Material and methods: A retrospective comparative study was performed; it included 263 patients who underwent elective abdominal surgeries from a single institution. Coagulation tests were compared with sex, age groups, intra- or postoperative bleeding, surgical time and length of hospital stay. Results: A total of 2 (0.76%) intra or postoperative bleeding cases were found. Abnormal tests were reported in agreement with the International Normalized Ratio (INR) with minimal risk of bleeding (10/3.8%), INR with the maximal risk of bleeding (3/1.1%), PTT (66/25.1%) and PT (25/9.5%). There was no significant difference when coagulation tests were compared with sex, intra- or postoperative bleeding or surgical time. Abnormal INR with maximal risk of bleeding was more common in patients ≥ 60 years of age (p = 0.002). Surgical time and length of hospital stay were longer in patients with abnormal INR with maximal (p = 0.003) and minimal risk of bleeding (p = 0.005), respectively. Conclusions: Routine use of coagulation tests prior to elective abdominal surgery has no justification. It should be avoided.


REFERENCES

  1. Smetana GW, Macpherson DS. The case against routine preoperative laboratory testing. Med Clin North Am. 2003; 87: 7-40.

  2. Nazar CJ, Bastidas JE, Lema GF. Exámenes preoperatorios de rutina en cirugía electiva ¿cuál es la evidencia? Rev Chil Cir. 2014; 66: 188-193.

  3. Munro J, Booth A, Nicholl J. Routine preoperative testing: a systematic review of the evidence. Heatlh Technol Assess. 1997; 1: 1-62.

  4. Norma Oficial Mexicana NOM-006-SSA3-2011, Para la práctica de la anestesiología.

  5. Agha RA, Borrelli MR, Vella-Baldacchino M, Thavayogan R, Orgill DP, for the STROCSS Group. The STROCSS Statement: Strengthening the Reporting of Cohort Studies in Surgery. Int J Surg. 2017; 46: 198-202.

  6. Cano I, Cruz J. Protocolo para el manejo perioperatorio de pacientes con alteraciones de la hemostasia. Complejo hospitalario la mancha centro Internet. 2004. [Cited Diciembre 2004]; About 26 p. Disponible en: http://cgdhospitaldelhenares.weebly.com/

  7. Rohrer MJ, Michelotti MC, Nahrwold DL. A prospective evaluation of the efficacy of preoperative coagulation testing. Ann Surg. 1988; 208: 554-557.

  8. Velanovich V. The value of routine preoperative laboratory testing in predicting postoperative complications: a multivariate analysis. Surgery. 1991; 109: 236-243.

  9. Schramm B, Leslie K, Myles PS, Hogan CJ. Coagulation studies in preoperative neurosurgical patients. Anesth Intensive Care. 2001; 29: 388-392.

  10. Curry AN, Pierce JT. Conventional and near-patient tests of coagulation. Contin Educ Anaesth Crit Care Pain. 2007; 7: 45-50.

  11. Peterson P, Hayes TE, Arkin CF, Bovill EG, Fairweather RB, Rock WA, Jr, et al. The preoperative bleeding time test lacks clinical benefit: College of American Pathologists’ and American Society of Clinical Pathologists’ position article. Arch Surg. 1998; 133: 134-139.

  12. De Hert S, Imberger G, Carlisie J, Diemunsh P, Fritsch G, Moppett K, et al. Task force on preoperative evaluation of the adult noncardiac surgery patient of the european society of anaesthesiology. Eur J Anaesthesiol. 2011; 28: 684-722.

  13. Barrio J, Peris V, Asensio I, Molina I, López F, García V. Tiempo de tromboplastina parcial activado prolongado no sospechado en cirugía de urgencia. Orientación diagnóstica y terapéutica. Rev Esp Anestesiol Reanim. 2002; 49: 424-427.

  14. Eisenberg JM, Clarke JR, Sussman SA. Prothrombin and partial thromboplastin times as preoperative screening tests. Arch Surg. 1982; 117: 48-51.

  15. Kozak EA, Brath LK. Do screening coagulation tests predict bleeding in patients undergoing fiberoptic bronchoscopy with biopsy? Chest. 1994; 106: 703-705.

  16. Morales-Orozco C, Mata-Miranda MP, Cárdenas-Lailson LE. Costo beneficio de las exámenes preoperatorios de rutina en cirugía electiva. Cir Cir. 2005; 73: 25-30.

  17. Durán-Nah JJ, Aké-Poot LA, Gómez- Vázquez C, Kim- Barrera RE, De la Cruz-Muñoz M, Moscoso-González P, et al. Abnormal pre-surgical tests and their association with tramp-surgical hemorrhagic complication in elective surgery. Gac Med Mex. 2004; 140: 281-288.

  18. Tumbull JM, Buck C. The value of preoperative screening investigations in otherwise healthy individuals. Arch Intern Med. 1987; 147: 1101-1105.

  19. Eroglu E, Sozmen BO, Kayiran SM, Balci S, Gürakan B. Evaluation of coagulation tests before newborn circumcision: is it necessary? Blood Coagul Fibrinolysis. 2016; 27: 160-162.

  20. Asaf T, Reuveni H, Yermiahu T, Leiberman A, Gurman G, Porat A, et al. The need for routine pre-operative coagulation test (prothrombin time PT/partial thromboplastin time PTT) for healthy children undergoing elective tonsillectomy and/or adenoidectomy. Int J Pediatr Otorhinolaryngol. 2001; 61: 217-222.




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