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Fulltext Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

Sarin SK, Choudhury A, Sharma MK, Maiwall R, Al Mahtab M, Rahman S, et al.

Hepatol Int, 2019 Jul;13(4):353-390.
PMID: 31172417 DOI: 10.1007/s12072-019-09946-3

The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. With international groups volunteering to join, the "APASL ACLF Research Consortium (AARC)" was formed in 2012, which continued to collect prospective ACLF patient data. Based on the prospective data analysis of nearly 1400 patients, the AARC consensus was published in 2014. In the past nearly four-and-a-half years, the AARC database has been enriched to about 5200 cases by major hepatology centers across Asia. The data published during the interim period were carefully analyzed and areas of contention and new developments in the field of ACLF were prioritized in a systematic manner. The AARC database was also approached for answering some of the issues where published data were limited, such as liver failure grading, its impact on the 'Golden Therapeutic Window', extrahepatic organ dysfunction and failure, development of sepsis, distinctive features of acute decompensation from ACLF and pediatric ACLF and the issues were analyzed. These initiatives concluded in a two-day meeting in October 2018 at New Delhi with finalization of the new AARC consensus. Only those statements, which were based on evidence using the Grade System and were unanimously recommended, were accepted. Finalized statements were again circulated to all the experts and subsequently presented at the AARC investigators meeting at the AASLD in November 2018. The suggestions from the experts were used to revise and finalize the consensus. After detailed deliberations and data analysis, the original definition of ACLF was found to withstand the test of time and be able to identify a homogenous group of patients presenting with liver failure. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information and areas requiring future studies are presented here.

Matched MeSH terms: Blood Coagulation Disorders/etiology
Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

Sarin SK, Kedarisetty CK, Abbas Z, Amarapurkar D, Bihari C, Chan AC, et al.

Hepatol Int, 2014 Oct;8(4):453-71.
PMID: 26202751 DOI: 10.1007/s12072-014-9580-2

The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. Due to the rapid advancements in the knowledge and available information, a consortium of members from countries across Asia Pacific, "APASL ACLF Research Consortium (AARC)," was formed in 2012. A large cohort of retrospective and prospective data of ACLF patients was collated and followed up in this data base. The current ACLF definition was reassessed based on the new AARC data base. These initiatives were concluded on a 2-day meeting in February 2014 at New Delhi and led to the development of the final AARC consensus. Only those statements which were based on the evidence and were unanimously recommended were accepted. These statements were circulated again to all the experts and subsequently presented at the annual conference of the APASL at Brisbane, on March 14, 2014. The suggestions from the delegates were analyzed by the expert panel, and the modifications in the consensus were made. The final consensus and guidelines document was prepared. After detailed deliberations and data analysis, the original proposed definition was found to withstand the test of time and identify a homogenous group of patients presenting with liver failure. Based on the AARC data, liver failure grading, and its impact on the "Golden therapeutic Window," extra-hepatic organ failure and development of sepsis were analyzed. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals, and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information are presented here.

Matched MeSH terms: Blood Coagulation Disorders
Fulltext Maternal and foetal outcomes following natural vaginal versus caesarean section (c-section) delivery in women with bleeding disorders and carriers

Karanth L, Abas AB

Cochrane Database Syst Rev, 2021 Dec 09;12(12):CD011059.
PMID: 34881425 DOI: 10.1002/14651858.CD011059.pub4

BACKGROUND: Bleeding disorders are uncommon but may pose significant bleeding complications during pregnancy, labour and following delivery for both the woman and the foetus. While many bleeding disorders in women tend to improve in pregnancy, thus decreasing the haemorrhagic risk to the mother at the time of delivery, some do not correct or return quite quickly to their pre-pregnancy levels in the postpartum period. Therefore, specific measures to prevent maternal bleeding and foetal complications during childbirth, are required. The safest method of delivery to reduce morbidity and mortality in these women is controversial. This is an update of a previously published review.
OBJECTIVES: To assess the optimal mode of delivery in women with, or carriers of, bleeding disorders.
SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the Cochrane Pregnancy and Childbirth Group's Trials Register as well as trials registries and the reference lists of relevant articles and reviews. Date of last search of the Group's Trials Registers: 21 June 2021.
SELECTION CRITERIA: Randomised controlled trials and quasi-randomised controlled clinical trials investigating the optimal mode of delivery in women with, or carriers of, any type of bleeding disorder during pregnancy were eligible for the review.
DATA COLLECTION AND ANALYSIS: No trials matching the selection criteria were eligible for inclusion.
MAIN RESULTS: No trials matching the selection criteria were eligible for inclusion.
AUTHORS' CONCLUSIONS: The review did not identify any randomised controlled trials investigating the safest mode of delivery and associated maternal and foetal complications during delivery in women with, or carriers of, a bleeding disorder. In the absence of high quality evidence, clinicians need to use their clinical judgement and lower level evidence (e.g. from observational trials, case studies) to decide upon the optimal mode of delivery to ensure the safety of both mother and foetus. Given the ethical considerations, the rarity of the disorders and the low incidence of both maternal and foetal complications, future randomised controlled trials to find the optimal mode of delivery in this population are unlikely to be carried out. Other high quality controlled studies (such as risk allocation designs, sequential design, and parallel cohort design) are needed to investigate the risks and benefits of natural vaginal and caesarean section in this population or extrapolation from other clinical conditions that incur a haemorrhagic risk to the baby, such as platelet alloimmunisation.

Matched MeSH terms: Blood Coagulation Disorders*
Fulltext Normalisation of the International Normalised Ratio (INR) Prior to Interventional Procedure: is it necessary?

Mohd Tarmizi Mohamad Mahyedin, Afifah Hassan, Abdul Rahim Hussein

Malaysian Journal of Medicine and Health Sciences, 2018;14(201):1-7.
MyJurnal

The fresh frozen plasma (FFP) is frequently prescribed either for therapeutic or prophylactic transfusion. The international normalised ratio (INR) value of 1.50 and above is frequently reported to be a transfusion trigger for FFP prior to interventional procedure. This study aimed to evaluate the efficacy of prophylactic FFP transfusion in normalising the INR and to determine the post-transfusion outcomes. Methods: A prospective cross-sectional study involved 81 patients who received prophylactic FFP transfusion over a period of three months. All demographic, clinical data and outcomes of FFP transfusion were captured and filled in the research proforma. Results: The proportion of patients achieved posttransfusion INR below 1.51 was 30.30% (n=27). The majority of patients underwent the interventional procedures with posttransfusion INR > 1.50 (n=52) without experiencing any bleeding episodes. Overall, FFP transfusion resulted in significant median INR difference from 1.89 (IQR, 0.53) to 1.60 (IQR, 0.25); p< 0.001. The greater median INR difference was observed in group with pretransfusion INR > 2.00 and who received FFP doses between 10.00 to 20.00 ml kg-1 (p < 0.001). The INR difference showed the significant, positive correlation with pretransfusion INR values (rs= 0.83, p < 0.001) and FFP doses (rs= 0.72, p< 0.001). Conclusions: The interventional procedures were safely carried out despite abnormal posttransfusion INR. The prophylactic FFP transfusions could be avoided in patients with mild coagulopathy (INR 1.50 - 2.00) prior interventional procedures.

Matched MeSH terms: Blood Coagulation Disorders
Fulltext Streptokinase after Spinal Anaesthesia – A Case Report

Hadi, M.R.A., Basri, M.N., Ariff, O.

International Medical Journal Malaysia, 2006;5(1):1-4.
MyJurnal

The use of thrombolytic agent e.g. streptokinase is indicated in patients with early acute ST elevation myocardial infarction (MI) (if there are no contraindications) is becoming increasingly routine. Its use is however significantly limited by bleeding complications. Spinal epidural haematoma (SEH) is haemorrhage in the spinal epidural space after spinal anaesthesia. SEH may be acute or chronic, spontaneous, posttraumatic, or iatrogenic but its occurrence appears to be particularly associated with acquired coagulopathy from medications and disease states. Patients usually present with acute axial spine pain and evolving focal neurological deficits. With increasing number of available anticoagulants and patient receiving them, anaesthesiologists today have to face the challenge of balancing between risks and benefits of regional anesthesia in patients under such medications. The treatment of this condition involves the principles of conservative follow-up directed by an improving examination and an understanding of the pathophysiology of coagulopathy-induced spontaneous epidural bleeds. When the diagnosis is accomplished rapidly, surgical decompression can result in full functional recovery.

Matched MeSH terms: Blood Coagulation Disorders
Coagulopathy in acute head injury--a study of its role as a prognostic indicator

Selladurai BM, Vickneswaran M, Duraisamy S, Atan M

Br J Neurosurg, 1997 Oct;11(5):398-404.
PMID: 9474270

The aim of this investigation was to determine the prognostic value of coagulation abnormalities in a defined subset of patients with acute head injury. Prothrombin time, accelerated partial thromboplastin time (APTT), thrombin clotting time, fibrinogen assay, platelet count, fibrin degradation products (FDP) were assayed in 204 patients with acute closed head injury. Their values were graded on a score 0-3 and the sum score for each patient regarded as the disseminated intravascular coagulation (DIC) score. Moderate to severe DIC scores were evident in 38% of the cohort. At least one parameter was abnormal in 71% of patients. The DIC score correlated inversely with the Glasgow coma score (GCS) (p < 0.0001). In the GCS 13-15 subset, FDP scores were significant predictors of poor outcome (p < 0.001). In the GCS 6-12 subset, the APTT score (p < 0.001), and DIC score (p < 0.0001) predicted an adverse outcome. The DIC scores were significantly abnormal in most patients who had a poor outcome, without evidence of adverse predictors on CT. Logistic regression analysis confirmed the independent predictive capacity of APTT, FDP and DIC scores when values for GCS were fixed. Abnormal haemostatic parameters may enhance the predictive ability in subsets of patients with acute head injury defined by clinical or CT predictors.

Matched MeSH terms: Blood Coagulation Disorders/blood*; Blood Coagulation Disorders/complications
Dental management of people with complex or rare inherited bleeding disorders

Nanayakkara L, Yahaya N, Parreira M, Bajkin B

Haemophilia, 2024 Apr;30 Suppl 3:128-134.
PMID: 38571337 DOI: 10.1111/hae.15005

Advances in haematological therapies for people with complex or rare inherited bleeding disorders (IBD) have resulted in them living longer, retaining their natural teeth with greater expectations of function and aesthetics. Dental management strategies need to evolve to meet these challenges. Utilising low level laser diode therapy to reduce pre-operative inflammation to reduce the intraoperative and postoperative burden on haemostasis is described in a case series of 12 patients. For these individuals who previously required further medical management to support haemostasis or experienced such prolonged haemorrhage sufficient to warrant hospital admission, haemostasis was achieved in the dental surgery such that they were able to return home with no further medical intervention or overnight stays. Global inequities in accessing novel treatments for complex or rare IBD necessitates a comprehensive understanding of the local haemostatic agents available to dentists and the most commonly used agents and techniques are described including the use of single tooth anaesthesia (STA). STA is a computerised delivery mechanism that allows routine dental procedures that would previously have required block injections needing factor replacement therapy to be undertaken safely and effectively with no additional haemostatic intervention. The challenges of inhibitors in oral surgery are explained and discussed although more research and evidence is required to establish new treatment protocols. The importance of establishing good dental health in the quality of life of people with complex or rare IBD is highlighted with respect to the dental specific impact that more novel therapies may have on people with IBD.

Matched MeSH terms: Blood Coagulation Disorders, Inherited*
Fulltext Evaluation of the geographical utility of Eastern Russell's viper (Daboia siamensis) antivenom from Thailand and an assessment of its protective effects against venom-induced nephrotoxicity

Chaisakul J, Alsolaiss J, Charoenpitakchai M, Wiwatwarayos K, Sookprasert N, Harrison RA, et al.

PLoS Negl Trop Dis, 2019 10;13(10):e0007338.
PMID: 31644526 DOI: 10.1371/journal.pntd.0007338

BACKGROUND: Daboia siamensis (Eastern Russell's viper) is a medically important snake species found widely distributed across Southeast Asia. Envenomings by this species can result in systemic coagulopathy, local tissue injury and/or renal failure. While administration of specific antivenom is an effective treatment for Russell's viper envenomings, the availability of, and access to, geographically-appropriate antivenom remains problematic in many rural areas. In this study, we determined the binding and neutralizing capability of antivenoms manufactured by the Thai Red Cross in Thailand against D. siamensis venoms from four geographical locales: Myanmar, Taiwan, China and Thailand.
METHODOLOGY/PRINCIPLE FINDINGS: The D. siamensis monovalent antivenom displayed extensive recognition and binding to proteins found in D. siamensis venom, irrespective of the geographical origin of those venoms. Similar immunological characteristics were observed with the Hemato Polyvalent antivenom, which also uses D. siamensis venom as an immunogen, but binding levels were dramatically reduced when using comparator monovalent antivenoms manufactured against different snake species. A similar pattern was observed when investigating neutralization of coagulopathy, with the procoagulant action of all four geographical venom variants neutralized by both the D. siamensis monovalent and the Hemato Polyvalent antivenoms, while the comparator monovalent antivenoms were ineffective. These in vitro findings translated into therapeutic efficacy in vivo, as the D. siamensis monovalent antivenom was found to effectively protect against the lethal effects of all four geographical venom variants preclinically. Assessments of in vivo nephrotoxicity revealed that D. siamensis venom (700 μg/kg) significantly increased plasma creatinine and blood urea nitrogen levels in anaesthetised rats. The intravenous administration of D. siamensis monovalent antivenom at three times higher than the recommended scaled therapeutic dose, prior to and 1 h after the injection of venom, resulted in reduced levels of markers of nephrotoxicity and prevented renal morphological changes, although lower doses had no therapeutic effect.
CONCLUSIONS/SIGNIFICANCE: This study highlights the potential broad geographical utility of the Thai D. siamensis monovalent antivenom for treating envenomings by the Eastern Russell's viper. However, only the early delivery of high antivenom doses appears to be capable of preventing venom-induced nephrotoxicity.

Matched MeSH terms: Blood Coagulation Disorders/drug therapy
Does automation play a role in coagulation studies in Southeast Asian countries

George E

Southeast Asian J. Trop. Med. Public Health, 1979 Sep;10(3):319-20.
PMID: 515794
Matched MeSH terms: Blood Coagulation Disorders/diagnosis
Fulltext Coagulation Factor Activities Changes Over 5 Days in Thawed Fresh Frozen Plasma Stored at Different Initial Storage Temperatures

Noordin SS, Karim FA, Mohammad WMZBW, Hussein AR

Indian J Hematol Blood Transfus, 2018 Jul;34(3):510-516.
PMID: 30127563 DOI: 10.1007/s12288-017-0879-8

Thawed plasma is fresh frozen plasma (FFP) that has been stored for 5 days at 1-6 °C. Duration of storage and different storage temperatures might affect the coagulation factor activity in thawed FFP. This study measured the changes of coagulation factor activities over 5 days in thawed FFP and stored at two different initial storage temperatures. Thirty-six units of FFP, which consisted of nine units each from blood groups A, B, AB, and O, were thawed at 37 °C. Each unit was divided into two separate groups (Group A and Group B) based on initial storage temperature. The first group was stored at 2-6 °C for 5 days (Group A). The second group was stored at 20-24 °C for initial 6 h followed by 2-6 °C for 5 days (Group B). Prothrombin time (PT), activated partial thromboplastin time (APTT), coagulation factor activities of fibrinogen, factor (F) II, FV, FVII, FVIII, FIX, FX, and von Willebrand factor antigen (vWF Ag) were assessed at baseline after thawing, at 6 h, and on days 1, 3, and 5 of storage for both groups. All coagulation factors mean activities in both storage groups decreased significantly over 5 days of storage. The mean FVIII activity at day 5 of storage was 36.9% in Group A and 39.8% in Group B. The other coagulation factors mean activities were > 50% on day 5 of storage in both groups. The coagulation factor activities of thawed FFP stored for 5 consecutive days were reduced in the two storage groups but most of the activities were still above 30%. This study suggests that thawed FFP stored for 5 days has the potential to ameliorate coagulation factor deficiencies in affected patients.

Matched MeSH terms: Blood Coagulation Disorders
Fulltext A glimpse on the function of chitosan as a dental hemostatic agent

Lestari W, Yusry WNAW, Haris MS, Jaswir I, Idrus E

Jpn Dent Sci Rev, 2020 Nov;56(1):147-154.
PMID: 33204370 DOI: 10.1016/j.jdsr.2020.09.001

Managing a bleeding patient can be a challenge during dental surgery. Profuse hemorrhage due to platelet defects, coagulation disorders, vascular anomalies, medication-induced patients, as well as inherited bleeding ailments result in soft tissue hematoma, septic shock, compromised airway, and in some severe cases, death could occur. A vast array of surgical hemostatic agents are available to stop bleeding, including chitosan-based hemostatic agents. Chitosan has an advantage over other topical hemostatic materials for its ability to promote shorter bleeding times and assist in healing. Massive behind-the-scene research and development efforts are ongoing to increase the performance of chitosan as a hemostatic agent. Numerous studies on chitosan use in dental hemostasis have registered it as being safe, biodegradable, biocompatible, promoting healing, antimicrobial and bioactive. This article reviews the application of chitosan in managing hemostasis in dental patients.

Matched MeSH terms: Blood Coagulation Disorders
A case of fatal envenomation by a captive puff adder (Bitis arietans) in Malaysia

Husain Z, Wicaksono AC, Renault A, Md Zhahir SS, Ismail AK

Toxicon, 2023 Mar 01;224:107023.
PMID: 36640813 DOI: 10.1016/j.toxicon.2023.107023

The Puff Adder (Bitis arietans) is a viper native to Africa and the Middle East. Envenomation by this species often requires the administration of appropriate antivenom in order to achieve a favorable outcome. A patient was bitten in both hands by a captive B. arietans presented to a teaching hospital in Malaysia. The patient developed painful progressive swelling on both limbs that extended to the chest, hypotension, hypokalemia with worsening anemia, thrombocytopenia, coagulopathy, and severe metabolic acidosis. The patient was managed supportively while waiting for the appropriate antivenom, Antivipmyn-Africa, from the Singapore Zoo. The patient developed cardiorespiratory arrest twice and did not recover from the second. The patient was pronounced dead 23 hours post-incident. The local unavailability of the appropriate antivenom may be the most important factor that contributed to the patient's death. There is also a need to amend the Malaysian Wildlife Act in order to prevent such cases from recurring.

Matched MeSH terms: Blood Coagulation Disorders*
Fulltext Doing less is better: challenges in complex polytrauma management - case report

Farah, N.A., Johar, M.J., Ismail, M.S.

Medicine & Health, 2018;13(1):251-258.
MyJurnal

Damage control resuscitation, characterized by hemostatic resuscitation with blood products, rapid arrest of bleeding and when possible, permissive hypotension with restricted fluid load form a structured approach in managing a polytrauma patient. When complicated with traumatic rhabdomyolysis however, permissive hypotension strategy may cause more harm resulting in subsequent ischaemicreperfusion injury and acute kidney injury. We present a case involving a 20-yearold man who was rolled over by a lorry and sustained an open unstable pelvic fracture with vascular injury and left lower limb ischaemia. Permissive hypotension strategy was pursued for 4 hours prior to bleeding control in OT. This was followed by protracted surgery of 6 hours. Coagulopathy, acute kidney injury and rhabdomyolysis ensued in the post-operative period and patient succumbed to his injury on Day 3 post-trauma. Challenges and pitfalls in managing a complex polytrauma patient and recent evidences on damage control resuscitation is discussed.

Matched MeSH terms: Blood Coagulation Disorders
The role of peripheral blood smear examination in the evaluation of suspected platelet-related disorders in children: A practical approach and an illustrated review

Tyrrell L, Scruggs M, Kerwin A, Kahwash SB

Malays J Pathol, 2022 Dec;44(3):397-413.
PMID: 36591709

Platelets, along with coagulation factors and vasculature, represent the three main compartments of hemostasis. Upon investigation of a suspected hemostasis disorder, platelet count, size and morphology often offer important clues to the diagnosis or help narrow the differential diagnosis. In this review, we describe a general approach to diagnosing platelet disorders, starting with easily obtained data such as findings of complete blood count (CBC) and microscopic review of a stained peripheral blood smear. We discuss general findings that help separate consumptive from underproduction thrombocytopenia. We further touch on inherited thrombocytopenia disorders after classifying them into those associated with small, normal sized or large platelets. Illustrative microscopic images are provided where contributory. We conclude with a suggested algorithmic step-by-step approach to investigating a suspected platelet disorder in children.

Matched MeSH terms: Blood Coagulation Disorders*
Fulltext Massive hemothorax following administration of intrapleural streptokinase

Chai FY, Kuan YC

Ann Thorac Med, 2011 Jul;6(3):149-51.
PMID: 21760848 DOI: 10.4103/1817-1737.82451

The administration of intrapleural streptokinase (IPSK) is widely practiced in the management of loculated empyema thoracis. To our knowledge, there have been only 4 cases of hemorrhagic complications attributed to the administration of IPSK reported in the literature. In this article, we report a case of a 17-year-old girl who received IPSK and developed shock, anemia, coagulopathy and massive hemothorax. Our discussion focuses on the hemorrhagic complication of chest tube insertion and the role of IPSK in blood clot lysis and inhibition of local hemostasis.

Matched MeSH terms: Blood Coagulation Disorders
Preventive transfusion in Dengue shock syndrome-is it necessary?

Lum LC, Abdel-Latif Mel-A, Goh AY, Chan PW, Lam SK

J Pediatr, 2003 Nov;143(5):682-4.
PMID: 14615749

We compared 53 patients with Dengue shock syndrome (DSS) who received preventive transfusions with 53 who did not. Significant differences in the development of pulmonary edema and length of hospitalization (P

Matched MeSH terms: Blood Coagulation Disorders/complications
Blood coagulation, fibrinolysis and coronary heart disease: observations in Malaysia

Loncin H, Gurian JM, Loncin ME

J Atheroscler Res, 1968 5 1;8(3):471-82.
PMID: 5660508
Matched MeSH terms: Blood Coagulation Disorders/epidemiology*
Macular haemorrhage in adult acute leukaemia patients at presentation and the risk of subsequent intracranial haemorrhage

Jackson N, Reddy SC, Harun MH, Quah SH, Low HC

Br J Haematol, 1997 Jul;98(1):204-9.
PMID: 9233585

Retinal changes are common in adult acute leukaemia patients at presentation, but whether they correlate with the risk of subsequent intracranial haemorrhage is unknown. A 4-year study has been carried out in 82 newly-diagnosed acute leukaemia patients, aged 12-77 years, who were studied prospectively for the presence of intra-retinal haemorrhages (IRH), white-centred haemorrhages (WCH), cotton-wool spots (CWS) and macular haemorrhages (MH). Groups with and without these features were compared for their risk of intra-cranial haemorrhage (ICH) within the first 30 d following diagnosis. There was no association between the incidence of ICH and the presence of IRH, WCH or CWS. However, 6/13 of those with MH developed ICH, compared to 6/69 of those without MH (relative risk 5.0, CI 95% [2.03-12.33], P=0.003). The only other identifiable risk factor for ICH was the M3 subtype of AML, but if the four cases of M3-AML were discounted from analysis, MH remained a highly significant risk factor for ICH. Patients with MH should be monitored intensively for the development of ICH, and receive priority in the allocation of platelets where these are in short supply.

Matched MeSH terms: Blood Coagulation Disorders/etiology
TRENDS IN OBSTETRICS

MACAFEE CH

Med J Malaysia, 1963 Jun;17:274-81.
PMID: 14060504
Matched MeSH terms: Blood Coagulation Disorders*
Fulltext Coblation tonsillectomy versus dissection tonsillectomy: a comparison of intraoperative time, intraoperative blood loss and post-operative pain

Izny Hafiz Z, Rosdan S, Mohd Khairi MD

Med J Malaysia, 2014 Apr;69(2):74-8.
PMID: 25241816 MyJurnal

The objective of this study was to compare the intraoperative time, intraoperative blood loss and post operative pain between coblation tonsillectomy and cold tonsillectomy in the same patient. A prospective single blind control trial was carried out on 34 patients whom underwent tonsillectomy. The patients with known bleeding disorder, history of unilateral peritonsillar abscess and unilateral tonsillar hypertrophy were excluded. Operations were done by a single surgeon using cold dissection tonsillectomy in one side while coblation tonsillectomy in the other. Intraoperative time, intraoperative blood loss and post operative pain during the first 3 days were compared between the two methods. Results showed that the intraoperative time was significantly shorter (p<0.001) and intraoperative blood loss was significantly lesser (p<0.001) in coblation tonsillectomy as compared to cold tonsillectomy. Post operative pain score was significantly less at 6 hours post operation (p<0.001) in coblation tonsillectomy as compared to cold tonsillectomy. However, there were no differences in the post operative pain scores on day 1, 2 and 3. In conclusion, coblation tonsillectomy does have superiority in improving intraoperative efficiency in term of intraoperative time and bleeding compared to cold dissection tonsillectomy. The patient will benefit with minimal post operative pain in the immediate post surgery duration.

Matched MeSH terms: Blood Coagulation Disorders

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