Page 18 - World Journal of Laparoscopic Surgery

WJOLS

M Riyad et al 10.5005/jp-journals-10033-1239
OriginaL articLe

Coagulation Profile is Randomly done but never Helps in

Preparation of Laparoscopic Surgery

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1 M Riyad, S Uddin, G Alsaied, A Alshareef, K Muhaimeed, Y Abdulkarim
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ABSTRACT inTRodUCTion
Study objective: To assess the usefulness of practicing pre- Prothrombin time (PT) and activated partial thrombo-
operative coagulations tests in preparation of laparoscopic
surgical procedures. plastin time (APTT), international normalization ratio
Design: Retrospective observational study. (INR), platelet count (PC) and bleeding time (BT) are
commonly ordered by clinicians as part of preoperative
Setting: king fahad medical city a tertiary-care referral center
in Saudi Arabia. assessment. In preparation of patient for laparoscopic
Method: five hundred and fifty adult patients scheduled procedure these tests are never missed in KSA and some
for elective laparoscopic surgery were studied to determine other countries like India. In Bangladesh though coagula-
whether plan of management was influenced by routinely done tion profile is not mandatory for all patients but still it is
bleeding time (BT), platelet count (Pc), prothrombin time (PT), widely practiced by the surgeons and anesthesiologists
activated partial thromboplastin time (APTT) and international
normalization ratio (INR). before laparoscopic procedure.
Results: No intervention or change of management was Evidence-based guidelines on the use of preopera-
identified in 463 patients whom coagulation profiles were done tive tests before elective surgery have been published
routinely as part of preoperative preparation. However, man- by the national institute for clinical excellence (NICE) a
agement plan was changed in 5 (5.75%) of 87 patients having
indications for coagulation profile test (p < 0.01). government organization in the UK in 2003 where these
Conclusion: The study shows that preoperative screening tests were not recommended routinely either in adult
tests for coagulopathies not suspected on the basis of detailed or in children before elective procedure in the absence
clinical information are unnecessary and should not be done. of positive family or personal history of bleeding dis-
Keywords: Coagulation profile, Indicated test, Indication, order. More recently British Committee for Standards
Intervention, Screening test. in Haematology has confirmed the NICE guidelines
How to cite this article: Riyad m, Uddin S, Alsaied G, Alshareef appropriateness regarding this. American Society of
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A, Muhaimeed K, Abdulkarim Y. Coagulation Profile is Randomly
done but Never Helps in Preparation of Laparoscopic Surgery. Anesthesiology (ASA) has published an advisory in 2002
World J Lap Surg 2015;8(1):16-20. saying that patient with negative abnormal bleeding
Source of support: Nil history does not require coagulation screening prior to
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surgery. A prospective study showed proper history
Conflict of interest: None
taking can safely and effectively supplement preoperative
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screening test for coagulopathy. British committee for
1 Associate Professor and Ex. Resident, Assistant consultant standards in haematology also stated that unnecessary
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3,5,6 consultant, Resident testing can delay surgery in appropriately because of low
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1 Ad-din Medical College Hospital, Dhaka, Bangladesh; positive predictive value of these tests. Canadian anes-
Department of General Surgery, king fahad medical city thesiologist society (CAS) published a simple guidelines
Riyadh, Saudi Arabia regarding routine preoperative coagulation test. In a
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2,4 Department of General Surgery, king fahad medical city systemic review done in Johns Hopkins University School
Riyadh, Saudi Arabia of Medicine in 2005 conclude that there is very insufficient
3 Department of General Surgery and IcU, king fahad medical evidence to conclude that abnormal test results predict
city, Riyadh, Saudi Arabia
peroperative bleeding and suggested RCT to provide
5 Department of Hepatobiliary Surgery, king fahad medical strong evidence. On the other hand, Italian Society for
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city, Riyadh, Saudi Arabia
Haemostasis and thrombosis recommended that PT, PTT,
6 Department of Oncology Surgery, king fahad medical city
Riyadh, Saudi Arabia INR should be performed routinely before any invasive
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or surgical procedure. There are many other studies
Corresponding Author: m Riyad, Associate Professor
and Ex. Resident, Ad-din medical college Hospital, Dhaka and case reports supporting preoperative some sorts
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Bangladesh; Department of General Surgery, King Fahad of coagulation profile. Most of the country in Europe
Medical City, Riyadh, Saudi Arabia, e-mail: foysol_doctor@ follow NICE guidelines and some other country is try-
yahoo.com
ing to prove this thought in their population for specific
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