Usefulness of prothrombin and activated partial thromboplastin time in the preoperative assessment of hemostasis in pediatrics

Usefulness of PT and APTT in the preoperative assessment of hemostasis in pediatrics.

Abstract

To evaluate hemostasis preoperatively, a directed clinical history and physical examination are indicated, and the use of routine coagulation being recommended when there is some indication, and not routine; 

Objective: the present study aims to know the usefulness of PT and APTT in the preoperative assessment of coagulopathies in scheduled minor and outpatient surgeries.

Methods: A prospective, observational study was conducted in a tertiary surgical hospital; We select patients undergoing minor and outpatient procedures, excluding those with comorbidities, surgical risk of high bleeding, or with medication that interferes with coagulation.

Results: 69 patients were recruited, the clinical history and the directed physical examination were applied, identifying 1 patient suspected of coagulation disorder (later discarded); 218 complementary tests were performed: 69 routine (PT, APTT, blood count) and 149 non-routine (arbitrarily indicated), obtaining mean values in normal ranges and not being able to identify or rule out coagulation disorders with them, but observing 21% ( 15 cases) abnormal results (false positives), which additionally led to behaviors to confirm or correct these values, ranging from repeating the test to transfusing blood products; generating a global average cost of 102 Bs. per patient, without a benefit or change in clinical or surgical behavior.

Conclusion: the study established that routine preoperative screening tests have little utility and are little cost-beneficial in the assessment of the hemostasis for minor or outpatient procedures, compared to a history and directed physical examination; its indication being appropriate when there are abnormal findings in the physical examination and clinical history or based on concomitant diseases.