title: Post-tonsillectomy bleeding in children with von Willebrand disease: a single-institution experience.
abstract: 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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Rodriguez
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Sun
authors.forename: Francis
authors.initials: F
authors.lastname: Pike
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Mandel
authors.forename: Margaretha L
authors.initials: ML
authors.lastname: Casselbrant
authors.forename: David H
authors.initials: DH
authors.lastname: Chi
mesh_terms: 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
chemical_list: D003894:Deamino Arginine Vasopressin