title: Major haemorrhage related to surgery in patients with type 1 and possible type 1 von Willebrand disease.
abstract: Patients with von Willebrand disease (VWD) frequently bleed under a challenge. The aim of our study was to identify predictive markers of perioperative major haemorrhage in type 1 (VWF:RCo = 15-30 IU dl(-1)) and possible type 1 (VWF:RCo = 31-49 IU dl(-1)) VWD patients. We recorded perioperative bleeding complications previous to diagnosis and laboratory parameters in 311 patients with 498 surgical procedures. The patients were grouped according to the absence (A) or presence (B) of perioperative major haemorrhages. Eighty-one patients (26%) and 87 surgical procedures (17.5%) presented major haemorrhages associated with surgeries. There was no difference between the percentage of type 1 and possible type 1 VWD patients who had major haemorrhages (32.6% and 24.8% respectively; p = ns). No difference in the prevalence of O blood group, age, gender, positive family history and laboratory test results (FVIII and VWF) was observed, independent of the haemorrhagic tendency. Bleeding after tooth extraction was the most frequent clinical feature observed in patients with perioperative major haemorrhages. The bleeding score and the number of bleeding sites (> or = 3) were not predictors of major haemorrhage associated with surgery. Caesarean section and adenotonsillectomy showed the highest frequency of major haemorrhages (24.6% and 22.3%, respectively). In conclusion, type 1 and possible type 1 VWD patients showed similar incidence of perioperative major haemorrhages. Laboratory tests and positive family history did not prove to be effective at predicting major haemorrhages in patients that had either type 1 or possible type 1 VWD. The history of bleeding after tooth extraction could define risk factors of major haemorrhage.
authors.affiliation: Departamento de Hemostasia y Trombosis, Instituto de Investigaciones Hematológicas, Academia Nacional de Medicina (Buenos Aires), Pacheco de Melo 3081; (C1425AUM) Buenos Aires, Argentina. aiwoods@hematologia.anm.edu.ar
authors.forename: Adriana Inés
authors.initials: AI
authors.lastname: Woods
authors.forename: Alicia Noemí
authors.initials: AN
authors.lastname: Blanco
authors.forename: Roberto
authors.initials: R
authors.lastname: Chuit
authors.forename: Susana Sara
authors.initials: SS
authors.lastname: Meschengieser
authors.forename: Ana Catalina
authors.initials: AC
authors.lastname: Kempfer
authors.forename: Cristina Elena
authors.initials: CE
authors.lastname: Farías
authors.forename: María Angela
authors.initials: MA
authors.lastname: Lazzari
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002585:Cesarean Section / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000097:blood / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D014068:Tonsillectomy / Q000009:adverse effects; D014081:Tooth Extraction / Q000009:adverse effects; D055815:Young Adult; D014842:von Willebrand Diseases / Q000097:blood / Q000150:complications* / Q000628:therapy
chemical_list: D015415:Biomarkers