Preoperative screening for coagulopathy using prothrombin time and partial thromboplastin time in patients requiring primary cranial vault remodeling

The aim of this study was to investigate the prevalence of abnormal preoperative screening prothrombin time and partial thromboplastin time in patients listed for primary cranial vault remodeling that required hematologic workup and their diagnoses and subsequent management. This retrospective analysis was performed from January of 2000 to December of 2003 at the International Craniofacial Institute, Dallas, Texas, on a total of 168 patients. All patients had a normal prothrombin time. Abnormally raised partial thromboplastin time was found in six patients (prevalence of 3.57 percent), one who had factor XI deficiency, one who had a borderline factor XI deficiency and circulating inhibitor, one who had an intermittent factor XI deficiency and circulating inhibitor, one who had a borderline von Willebrand's disease with low factor XII, and the remaining two who had a circulating inhibitor of coagulation. Of these six patients, the perioperative management was altered in four of five patients, and one patient declined surgery out of fear of surgical morbidity. The surgery of one patient was aborted intraoperatively because of abnormal bleeding without clot formation after the calvarial burr holes had been drilled. The mean blood loss was 183 ml for the four patients with completed surgery and 100 ml for one patient. The authors conclude that even though the prevalence of abnormal screening partial thromboplastin time in these patients was low (3.57 percent), detection of an abnormal result required preoperative correction of coagulopathy in 80 percent of cases.