Between a Rock and a Hard Place: Anticoagulating an Adolescent with Post-Tonsillectomy Massive PE: A Case Report

Ann Otol Rhinol Laryngol. 2023 Mar;132(3):346-350. doi: 10.1177/00034894221088178. Epub 2022 Apr 3.


Objectives: To report a case of a morbidly obese 17-year-old boy who presented 4 days post-tonsillectomy with acute deep venous thromboses and a massive pulmonary embolism. To describe a protocol and decision-making tree for providing anticoagulation in the immediate post-tonsillectomy period.

Methods: A chart review and review of the literature.

Results: The patient ultimately did well and had no bleeding from the tonsil beds or further thromboembolic complications. A review of the literature revealed no available data regarding the safety of anticoagulation in the immediate post-tonsillectomy period.

Conclusions: We propose that if anticoagulation is needed within 14 days of tonsillectomy, submaximal anticoagulation with a reversible and titratable anticoagulant may be optimal. A multidisciplinary team approach is needed for these complex cases. Future reporting and investigation of anticoagulation post-tonsillectomy is needed.

Keywords: miscellaneous; obstructive sleep apnea; pediatric OSA surgical treatment; pediatric obstructive sleep apnea; pediatric otolaryngology; pediatric tonsillectomy and adenoidectomy; post operative complications; tonsillectomy.

Publication types

  • Review
  • Case Reports

MeSH terms

  • Adenoidectomy / methods
  • Adolescent
  • Humans
  • Male
  • Obesity, Morbid*
  • Retrospective Studies
  • Sleep Apnea, Obstructive* / surgery
  • Tonsillectomy* / adverse effects
  • Tonsillectomy* / methods