Page 19 - World Journal of Laparoscopic Surgery

WJOLS

Coagulation Profile is Randomly done but never Helps in Preparation of Laparoscopic Surgery
operations. For instance, coagulation status is routinely scheduled operation list published and distributed day
checked before any operative procedure in Germany but before surgery.
German Society for Ear-Nose-Throat-Medicine, Head and To identify patients predisposed to an abnormal
Neck Surgery (DGHNO), the Working Group Paediatric coagulation system, a comprehensive list of indications
Anaesthesiology of the German Society of Anaesthesio- (Table 1) for preoperative coagulation testing was derived
logy and Intensive Care Medicine (DGAI), the German with guidance of CAS guidelines, ASA advisory and
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Society of Paediatric Medicine (DGKJ), and the Paediatric Harvard medical school study. Based upon the listed
Committee of the German Society of Thrombosis and questionnaire patients file was reviewed to divide them
Haemostasis Research (GTH), published in the Deutsches into ‘Indicated test group’ and ‘Screening test group’.
Ärzte blatt in 2006, stressed that coagulation screening Indicated test group patients were those whom coagula-
is not useful in the preoperative setting and advised to tion test results might had been abnormal due to specific
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draw more attention on the patient’s detailed history. findings in history and physical examination. Screening
It is obvious that preoperative routine coagulation tests group patients were those whom these investiga-
profile is still in practice and a matter of contention tions were not specifically needed; therefore, were done
between the physicians. In most of the country, it is con- as screening for an unsuspected coagulopathy (Flow
sidered as an obligatory part of preoperative evaluation Chart 1).
for laparoscopic surgery. One of the reasons behind that Preoperative INR, PT, PTT, BT and PC results
is surgeon is very much cautious about bleeding during recorded from hospital electronic data base system. Post-
laparoscopic procedures, others are more general, to operative results (up to 28 days postoperative period)
detect unsuspected abnormalities that might influence also searched and recorded when available. Any change
the risk of operative morbidity and mortality; establishing of management plan to overcome the abnormal results
a baseline value for a test that has a likelihood of being termed as ‘Intervention’, was identified from physician
monitored and changing after the surgical procedure; order documented in the file. Cancellation of procedure,
for medicolegal reasons; and as a tradition in individual transfusion of packed RBC, whole blood in excess of
institutional practices. normal due to coagulopathy, transfusion of fresh frozen
Here in Saudi Arabia, we found that no patients plasma, platelets, or other coagulation factors and Vit K
undergo elective surgical procedures without coagulation
testing. In our institution, a tertiary referral hospital in Table 1: Indications to request preoperative coagulation profile
the capital drawing a general catchment from all over the • Bleeding diathesis, family Prolonged bleeding
country PT, PTT, INR, BT and PC is a routine practice for history of bleeding disorder Excessive bleeding
all elective surgical patients. Science already proven that Easy bruising
routine preoperative investigations is not necessary by Unable to give history
the major medical societies of the world, we decided to • Anticoagulant therapy Aspirin
check if there is any role of coagulation profile in prepa- Heparin, Enoxaparine
Dipyridamole
ration of patient for laparoscopy surgery. Warfarin
Nonsteroidal anti-inflammatory
STUdY dESiGn drugs
• Past medical history History of deep venous
Retrospective chart review. thrombosis or pulmonary
embolism.
SETTinGS chronic renal failure on dialysis
cirrhosis, jaundice
Department of surgical specialties, King Fahad Medi- Splenic disease
cal City a tertiary care super specialized referral center, Platelet dysfunction
Riyadh, Saudi Arabia. Thrombocytopenia
• malignancy metastatic carcinoma
METHodS malignancy with radio-
chemotherapy
Upon approval from institutional review board (IRB) • Physical examinations Petechiae
all patients underwent elective laparoscopy surgery in Ecchymosis
the year 2009 was identified from operation theater and Jaundice
anesthesia department co-ordinated data base system. Hepatomegaly, nodular liver
We excluded pediatric patients, emergency procedures Ascitis
and pregnant patients. Elective surgery was defined as Splenomegaly
World Journal of Laparoscopic Surgery, January-April 2015;8(1):16-20 17