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Évaluation préanesthésique de l’hémostase dans les cliniques privées du Nord-Pas-de-Calais 1 Une partie des résultats de ce travail a été présentée lors du 41 e Congrès national d’anesthésie et de réanimation à Paris, le 24 septembre 1999 et publié sous forme de résumé (R337)
Abstract
Objectives: This study aimed at: i) stating what the routines are regarding ordering of preoperative coagulation test ; ii) evaluating the impact on the use of pre-operative orders from the data obtained during the first and the second parts of the study.Study design: Descriptive and comparative epidemiologic studyPatients and methods: This study was performed twice, and lasted for one day each during two consecutive years (1998 and 1999). It concerned 22 private clinics in the French region ‘Nord-Pas-de-Calais’. The anaesthesiologists who took part in the project had to fill out an easy and brief questionnaire concerning each patient who had been admitted to the operating area. It dealt mainly with the presence or the absence, of a preoperative laboratory screening, and with who ordered the test and which tests. The results of the first part of the study (1998) have been evaluated several times with the involved anaesthesiologists. Before repeating the study in 1999, the results were first discussed and compared to the recommendations of the experts.Results: In 1998, preoperative coagulation tests were ordered for 81% of the patients (n=662), which in more than half the cases were ordered by an anaesthesiologists. In less than 5% of the cases, one or more abnormalities were detected out of which half were predictable because of the patients previous medical history. Only one of the patients in the study suffered from an haemorrhagical problem although he had a normal coagulation screening. A year after, the ordering of a preoperative coagulation check included 75% of the patients (n=400), which represents a small but nonetheless significant decrease of the number of orders compared to 1998 (p
Introduction: Le bilan dhemostase est devenu une routine dans certains pays pour evaluer le risque hemorragique peri-operatoire. Lobjectif principal de cette etude etait devaluer les resultats des bilans dhemostase preoperatoires effectues au laboratoire dhematologie. Methodes et resultats:Une etude transversale retrospective descriptive et analytique a ete menee a lunite dhematologie du CHU Joseph Ravoahangy Andrianavalona pendant trois mois. Elle concernait des patients ayant realise des bilans dhemostase preoperatoires durant cette periode. Parmi 269 patients, 98 patients avaient des troubles de la coagulation preoperatoire. Le taux de prothrombine (TP) bas predominait dans 38,1% des cas, dont 68,9% etaient isoles et 31,1% etaient associes a lallongement de temps de cephaline active (TCA). La thrombocytose a ete retrouvee dans 37,3% des cas, la thrombocytopenie dans 15,3%. Lallongement du TCA a ete retrouve dans 9,3% des cas. Conclusion:Lesbilans dhemostase preoperatoire standards ne peuvent a eux seuls predire le risque de saignement. Leur prescription doit etre selective en fonction des antecedents et de la clinique. La recherche de letiologie des anomalies est importante pour ameliorer la prise en charge peri et post-operatoire.
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