Retrospective review of the management of elective surgery with desmopressin and clotting factor concentrates in patients with von Willebrand disease.
Limited data are available regarding optimal treatment with desmopressin (DDAVP) or intermediate-purity FVIII concentrates rich in VWF (CFCs) in patients with von Willebrand disease (VWD) who undergo planned surgery. We undertook a retrospective review over 10 years (1988-1997) and identified 27 patients treated with DDAVP for 35 surgical events and 38 patients who received CFCs for 68 elective surgical events. Tranexamic acid was usually added for mucosal surgery. The FVIII:C levels and the severity of surgery were used to determine the frequency and the doses of postoperative treatment. For major surgery the median pre- and post-operative doses of CFCs were 54 and 43 IU/kg, respectively, and for minor surgery the median doses varied between 34 and 52 IU/kg preoperatively and between 23 and 37 IU/kg postoperatively. The effectiveness of haemostasis was excellent in 32 events (91%) treated with DDAVP and in 56 events (82%) treated with CFCs. It is concluded that patients with VWD do not carry an increased operative risk if appropriate therapy is given.
Haemophilia Centre and Haemostasis Unit, Royal Free and University College Medical School, Pond Street, London, United Kingdom. iona@rfhsm.ac.uk
I C
IC
Nitu-Whalley
A
A
Griffioen
C
C
Harrington
C A
CA
Lee
D000773:Anesthesia, Obstetrical; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002585:Cesarean Section; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D017558:Elective Surgical Procedures; D005169:Factor VIII / Q000032:analysis / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011229:Preanesthetic Medication; D011247:Pregnancy; D012189:Retrospective Studies; D013515:Surgery, Oral; D013514:Surgical Procedures, Operative / Q000145:classification; D014148:Tranexamic Acid / Q000627:therapeutic use; D016896:Treatment Outcome; D014842:von Willebrand Diseases / Q000150:complications / Q000188:drug therapy*; D014841:von Willebrand Factor / Q000627:therapeutic use*
D000933:Antifibrinolytic Agents; D014841:von Willebrand Factor; D014148:Tranexamic Acid; D005169:Factor VIII; D003894:Deamino Arginine Vasopressin