Clinical and laboratory markers predicting VWD associated bleeding in surgery

MESCHENGIESER SS; WOODS AI; SÁNCHEZ LUCEROS A; BLANCO AN; KEMPFER AC; LAZZARI MA

Buenos Aires

Congreso; XXIX International Congress of the World Federation of Hemophilia; 2010

World Federation of Hemophilia

Patients with von Willebrand disease (VWD) can present excessive bleeding following surgery or invasive procedures. Coagulation testing or bleeding history has been used to identify predictive markers of perioperative bleeding with inconsistent results. We recorded the surgical bleeding complications of 311 patients with type 1 or possible type 1 and 51 patients with type 2 (2A, 2M, and 2B) previous to the diagnosis of VWD with the aim of identifying laboratory or clinical predictive markers of postoperative bleeding. 81/311 patients type 1 and possible type 1 (26%) and 87/498 surgical procedures (17.8%) presented major bleeding related to surgery without differences between type 1 (32.6%) and possible type 1 (24.8%). In type 2, 28/51 patients (54.9%) and 38/76 surgical procedures (50%) presented major bleeding. No difference was observed in the prevalence of O blood group, age, gender, family history or laboratory results in patients with and without surgical bleeding. Bleeding post-tooth extraction in type 1 and postpartum haemorrhage in type 2 were the most frequent clinical symptoms observed in patients with major perioperative haemorrhage. The highest frequency of major haemorrhage was associated with caesarian section (24.6% in type 1 and 66.6% in type 2), and adenotonsillectomy (22.6% in type 1 and 62.5% in type 2). Family history and laboratory tests were not useful as predictors of surgical bleeding in type 1, possible type 1, and type 2.