This article is more than 5 years old. Information may no longer be current.
Abnormal preoperative clotting seen in children with scoliosis
Click Here to Manage Email Alerts
Investigators from Ireland found children with scoliosis had abnormal preoperative coagulation profiles, which included prolonged prothrombin time, activation partial thromboplastin time and thrombin time, compared to controls.
“This study demonstrates that patients with scoliosis are more likely to statistically have an abnormal coagulation screening test preoperatively compared to normal controls,” Katie Ryan, a researcher from Dublin, said. “They are more likely to have a prolonged prothrombin time [PT], activation partial thromboplastin time [APTT] and thrombin time [TT], as well as reduced levels of factor X. There was no evidence of any difference between the idiopathic and nonidiopathic types of scoliosis. These results suggest a role for more detailed coagulation screening preoperatively in these patients.”
Pediatric patients with scoliosis may have a predisposition for preoperative coagulation abnormalities that may contribute to greater bleeding during surgery, according to Ryan.
Two groups studied
For the cross-sectional study, Ryan and colleagues examined two groups of patients aged 6 months to 18 years: a scoliosis cohort with no known coagulopathies and a non-scoliosis control group who underwent outpatient procedures, such as tonsillectomies or insertion of grommets. The researchers excluded patients in the control group with coagulopathies, major trauma or such major syndromes as Down syndrome or cerebral palsy. There were 165 patients in the scoliosis group and 175 patients in the control group.
There were a higher percentage of scoliosis patients with abnormal preoperative PT, APTT and TT, according to Ryan. The abnormal coagulation profiles of the scoliosis group totaled 67%, and 43% of the control group showed abnormal clotting. PT contributed the most to the abnormal coagulation profiles.
Abnormal PT was found in 62% of scoliosis patients compared to 33% of controls. The investigators found no significant differences for PT, APTT or TT between patients with idiopathic and nonidiopathic types of scoliosis.
Estimated bleeding
There were lower rates of extrinsic pathway factor X in the scoliosis group compared to the control group, which was a significant difference.
Because they did not record patient bleeding, the investigators could not calculate the sensitivity or specificity of the coagulation screening tests or the factor deficiencies for the study, Ryan noted.
“It was difficult to establish the amount of bleeding by retrospectively looking through the medical charts,” she said. “We need to establish whether patients in the scoliosis group have above average bleeding in a prospective study including variables such as intraoperative bleeding, number of levels fused and surgical approach. There is a lot of future research to be done.” — by Renee Blisard Buddle
- Reference:
- Ryan K. Paper #13-1463. Presented at: EFORT Congress; June 5-8, 2013. Istanbul.
- For more information:
- Katie Ryan can be reached at Our Lady’s Hospital for Sick Children, Crumlin, Dublin 12, Ireland; email: ktryan2@gmail.com.
Disclosure: Ryan has no relevant financial disclosures.