PMID- 36504262
OWN - NLM
STAT- MEDLINE
DCOM- 20230210
LR  - 20230210
IS  - 1442-200X (Electronic)
IS  - 1328-8067 (Linking)
VI  - 65
IP  - 1
DP  - 2023 Jan
TI  - Perioperative management in chronically anticoagulated children undergoing 
      tonsillectomy.
PG  - e15438
LID - 10.1111/ped.15438 [doi]
AB  - BACKGROUND: When undergoing tonsillectomy, patients at high risk of thrombosis 
      who require chronic anticoagulation therapy pose a special challenge as bleeding 
      may occur up to 2 weeks after surgery. Because of a lack of evidence-based data, 
      there is no consensus on the best management for such patients. The objective of 
      our study was to review perioperative anticoagulation bridging strategies in 
      children undergoing tonsillectomy. METHODS: The study group were a retrospective 
      series of patients on chronic anticoagulation therapy at high risk of a 
      thromboembolic event, who underwent tonsillectomy from 2010 to 2021. Patients 
      whose anticoagulation treatment was discontinued because of a low risk of 
      thromboembolic events were excluded. RESULTS: Four patients met the inclusion 
      criteria (age range, 1.5-16.1 years). All patients were admitted prior to surgery 
      for bridging therapy with intravenous unfractionated heparin (UFH), drip-titrated 
      to a therapeutic dose until 4-6 h prior to surgery. The estimated blood loss 
      during surgery was minimal in all surgeries. Unfractionated heparin was 
      readministered according to the hospital protocol on the night of surgery and 
      titrated to a therapeutic dose. Warfarin was restarted within 2 days postsurgery 
      for all patients. High-risk patients were kept in hospital until postoperative 
      day 6-8 because of concern for delayed bleeding. One patient was noticed to have 
      blood-tinged sputum requiring no intervention; none of the patients developed 
      early or delayed hematemesis. CONCLUSIONS: Our data show that bridging therapy 
      with UFH has been successful in chronically anticoagulated patients undergoing 
      tonsillectomy. These patients require multidisciplinary care for the management 
      of their pre- and postoperative course.
CI  - (c) 2022 Japan Pediatric Society.
FAU - Hazkani, Inbal
AU  - Hazkani I
AUID- ORCID: 0000-0002-8816-7141
AD  - Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie 
      Children's Hospital of Chicago, Chicago, Illinois, USA.
AD  - Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
FAU - Billings, Kathleen R
AU  - Billings KR
AD  - Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie 
      Children's Hospital of Chicago, Chicago, Illinois, USA.
AD  - Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
FAU - Edwards, Evan
AU  - Edwards E
AD  - Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
FAU - Stein, Eli
AU  - Stein E
AD  - Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
FAU - Bhat, Rukhmi
AU  - Bhat R
AD  - Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
AD  - Division of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie 
      Children's Hospital of Chicago, Chicago, Illinois, USA.
FAU - Lavin, Jennifer
AU  - Lavin J
AD  - Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie 
      Children's Hospital of Chicago, Chicago, Illinois, USA.
AD  - Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
LA  - eng
PT  - Journal Article
PL  - Australia
TA  - Pediatr Int
JT  - Pediatrics international : official journal of the Japan Pediatric Society
JID - 100886002
RN  - 9005-49-6 (Heparin)
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Humans
MH  - Child
MH  - Infant
MH  - Child, Preschool
MH  - Adolescent
MH  - Heparin/therapeutic use
MH  - Anticoagulants/therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects
MH  - Retrospective Studies
MH  - *Tonsillectomy/adverse effects
MH  - *Thromboembolism/prevention & control/chemically induced
MH  - Hemorrhage
MH  - Perioperative Care
OTO - NOTNLM
OT  - anticoagulation
OT  - pediatric tonsillectomy
OT  - postoperative hemorrhage
OT  - unfractionated heparin
EDAT- 2022/12/13 06:00
MHDA- 2023/02/11 06:00
CRDT- 2022/12/12 10:23
PHST- 2022/12/07 00:00 [revised]
PHST- 2022/04/26 00:00 [received]
PHST- 2022/12/07 00:00 [accepted]
PHST- 2022/12/13 06:00 [pubmed]
PHST- 2023/02/11 06:00 [medline]
PHST- 2022/12/12 10:23 [entrez]
AID - 10.1111/ped.15438 [doi]
PST - ppublish
SO  - Pediatr Int. 2023 Jan;65(1):e15438. doi: 10.1111/ped.15438.