Post-tonsillectomy bleeding in children with von Willebrand disease: a single-institution experience.
OBJECTIVE
1) Compare rates of post-tonsillectomy bleeding in pediatric patients with and without von Willebrand disease (vWD). 2) Identify factors that may increase the risk for post-tonsillectomy bleeding in children with and without vWD.


METHODS
Historical cohort study.


METHODS
Tertiary care, university-based pediatric hospital.


METHODS
Medical records were examined for 99 patients with vWD and 99 patients without vWD younger than 18 years who underwent tonsillectomy with or without adenoidectomy from August 1997 to October 2005. Subjects were matched for age, year of surgery, type of surgery, and indication for surgery.


RESULTS
Post-tonsillectomy hemorrhage occurred in eight of 99 (8%) vWD patients and in six of 99 (6%) non-vWD patients (P = 0.58, odds ratio 1.36, 95% CI 0.45-4.08). A two-sample test of proportions demonstrated lower and upper limits of -0.051 and 0.092. Four of eight children with vWD and two of six non-vWD patients required surgical intervention for control of bleeding. Ninety-three of 99 vWD patients received desmopressin acetate (DDAVP) preoperatively. In patients with vWD who responded to DDAVP challenge, there was no increased likelihood of post-tonsillectomy bleeding compared with non-vWD patients. No significant difference in the number of bleeding events was noted on the basis of demographics, preoperative laboratories, or use of aminocaproic acid.


CONCLUSIONS
Children with vWD undergoing tonsillectomy have a postoperative bleeding rate similar to that of a matched group. However, the sample size was not sufficient to eliminate the possibility of a clinically important difference between the two groups.
Rodriguez
Kenneth D
KD
Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Sun
Gordon H
GH
Pike
Francis
F
Mandel
Ellen M
EM
Casselbrant
Margaretha L
ML
Chi
David H
DH
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D014068:Tonsillectomy; D014842:von Willebrand Diseases / Q000150:complications* / Q000188:drug therapy
D003894:Deamino Arginine Vasopressin