The Administration of Fondaparinux in Strongly Suspected Heparin-Induced Thrombocytopenia (HIT): Further Evidence of Its Safety and Efficacy, and Need for a Controlled Randomized Study.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1072-1072
Author(s):  
Franco Piovella ◽  
Stefano Barco ◽  
Marisa Barone ◽  
Chiara Beltrametti ◽  
Mara De Amici
Keyword(s):  
Unfractionated Heparin ◽  
Bleeding Complications ◽  
Controlled Study ◽  
Severe Bleeding ◽  
Minor Bleeding ◽  
Heparin Induced Thrombocytopenia ◽  
Safety And Efficacy ◽  
Coronary Syndrome ◽  
Platelet Number ◽  
The Mean

Abstract Abstract 1072 Poster Board I-94 Introduction: Heparin-induced thrombocytopenia (HIT), alone or associated with thrombosis (HITT), may develop during anticoagulant treatment with unfractionated heparin (UFH) or low-molecular weight heparin (LWMH). Fondaparinux is a selective inhibitor of coagulation factor Xa which apparently does not react with anti-PF4/heparin antibodies in in vitro testing. Methods: From january 2005 to december 2007 we treated 44 patients who had strong suspect of HIT (12 patients) or HITT (32 patients, of whom 12 had both DVT and PE). Of these, 30 patients were previously exposed to unfractionated heparin (UFH) for major cardiac surgery. The remaining patients were admitted to medical or general surgery wards. In the 32 patients who developed HITT, we applied therapeutic dosages of fondaparinux, i.e. 7.5 mg QD or lower, in accordance with their bleeding risk. The remaining patients were treated with prophylactic dosages of fondaparinux, i.e. 2.5 mg QD. Switch to warfarin was performed as soon as possible. The mean of our patients 4T's score was 6.2, corresponding to high risk patients; the mean of anticorpal optical density (GTI Enhanced®) was 1.4; the mean platelet number was 45 × 109/L. Results: All patients but four showed sustained normalization of the platelet number. All patients but four showed a significant reduction of their thromboembolic burden. No death related to severe bleeding was recorded. Two episodes of major bleeding were recorded in post-surgical patients (4,5%); 4 episodes of minor bleeding were recorded (9,1%). Four patients underwent dialysis during fondaparinux without bleeding complications. One patient developed acute coronary syndrome during treatment with fondaparinux. Nine patients did not survive (20,5%), with a key role of primitive diseases (i.e. sepsis) causing delay in the diagnostic process of HIT (four of them had a diagnosis of HIT with a mean delay of 7 days). In 16 patients submitted to therapeutic dosages of fondaparinux, anti-PF4/heparin antibody titers were followed over time showing a constant decrease: in one case antibody levels did not decrease up to 6 months after stopping both heparin and fondaparinux. Thirty patients were easily switched from fondaparinux to VKAs without problems in reaching the appropriate INR target. Conclusions: This report provides further evidence supporting the safety and efficacy of fondaparinux in the treatment of HIT and underlines the importance of an early diagnosis. However, it shows the need of a randomized controlled study between fondaparinux and a registered comparator drug. Disclosures: Piovella: GlaxoSmithKline: Honoraria, Speakers Bureau; Bayer: Honoraria, Speakers Bureau; Boehringer Ingelheim: Honoraria, Speakers Bureau. Off Label Use: fondaparinux in the treatment of heparin-induced thrombocytopenia.

scholarly journals Safety and Efficacy of Enoxaparin Compared With Unfractionated Heparin for Venous Thromboembolism Prophylaxis in Hemodialysis Patients

2017 ◽  
Vol 52 (9) ◽  
pp. 623-627 ◽  
Author(s):  
Melissa S. Green ◽  
Katie B. Tellor ◽  
Amanda R. Buckallew
Keyword(s):  
Venous Thromboembolism ◽  
Unfractionated Heparin ◽  
Bleeding Complications ◽  
Secondary Outcome ◽  
Renal Elimination ◽  
Minor Bleeding ◽  
Safety And Efficacy ◽  
Vte Prophylaxis ◽  
Medically Ill ◽  
Medically Ill Patients

Background: Enoxaparin, a low-molecular-weight heparin approved for prophylaxis in patients at risk for venous thromboembolism (VTE), offers several advantages compared with unfractionated heparin (UFH). Enoxaparin is primarily excreted through renal elimination and is currently not recommended in patients receiving hemodialysis (HD) due to potential increased bleeding complications. To date, there are limited safety and efficacy data supporting the use of enoxaparin in this patient population for VTE prophylaxis. Objective: The aim of this study was to compare the safety and efficacy of enoxaparin with UFH for deep venous thromboembolism (DVT) prophylaxis in medically ill HD patients. Methods and Results: This retrospective cohort study examined medically ill patients who received HD and were concomitantly prescribed enoxaparin or UFH for at least 2 consecutive days for VTE prophylaxis. A total of 225 patients (150 received UFH and 75 received enoxaparin) were evaluated in chronological order. The primary outcome was a composite of major, clinically relevant nonmajor, and minor bleeding based on International Society on Thrombosis and Haemostasis bleeding definitions. The secondary outcome was the occurrence of a confirmed thrombotic event. Baseline characteristics were similar between the cohorts. One patient in each cohort had a documented bleed (UFH = 0.7%, enoxaparin = 1.3%, P > .05) during the admission assessed; however, neither bleed was related to the prophylactic agent utilized. No patients developed a VTE during the index hospitalization. Conclusions: This study demonstrates that enoxaparin may be as safe and effective as UFH for VTE prophylaxis in medically ill patients receiving HD.

Bleeding and haemostasis disorders

2018 ◽  
Author(s):  
Pier Mannuccio Mannucci ◽  
Maddalena Lettino
Keyword(s):  
Artery Bypass ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
High Rate ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Preventive Strategy ◽  
Stent Deployment ◽  
Coronary Syndrome ◽  
Coronary Syndromes

The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, and those with comorbid conditions such as renal and liver insufficiency and diabetes. The identification of patients at higher risk of bleeding is the most important preventive strategy. Red cell and platelet transfusions, which may become necessary in patients with severe bleeding, should be used with caution, because transfused patients with acute coronary syndrome have a high rate of adverse outcomes (death, myocardial infarction, and stroke).

Activated Recombinant Factor VII (rFVIIa/NovoSeven®) in the Treatment of Bleeding Complications Following Hematopoietic Stem Cell Transplantation (HSCT).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1135-1135 ◽  
Author(s):  
Benjamin Brenner ◽  
Markus Pihusch ◽  
Andrea Bacigalupo ◽  
Jeff Szer ◽  
Mario von Depka Prondzinski ◽  
...  
Keyword(s):  
Adverse Events ◽  
Initial Dose ◽  
Factor Vii ◽  
Bleeding Complications ◽  
Controlled Study ◽  
Severe Bleeding ◽  
Trial Period ◽  
Hematopoietic Stem ◽  
Coagulation Parameters ◽  
Transfusion Requirements

Abstract HSCT is a common treatment of hematological or oncological disorders. Many HSCT-associated complications, including prolonged aplasia, infection and graft-versus-host disease (GVHD) predispose to bleeding, resulting in increased morbidity and mortality. Platelet concentrates, fresh frozen plasma, antifibrinolytic agents or prothrombin complex concentrates are often ineffective. Although licensed for use in hemophilia pts with inhibitors, rFVIIa has been reported to be effective for the treatment of bleeding related to thrombocytopenia, thrombasthenia and other coagulation disorders. We conducted a multicenter, randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of rFVIIa in treatment of bleeding from days 2 to 180 after HSCT (F7BMT-1360 trial). Patients received rFVIIa (40, 80, 160 μg/kg) or placebo every 6h for 36h and were followed up for 96h after the initial dose. Exclusion criteria were recent thromboembolic events, atherosclerotic disease, DIC, thrombotic microangiopathy, venoocclusive disease and active AML (M3, M4, M5). The primary efficacy endpoint was the change in bleeding from 0h to 38h after initial dose. Secondary endpoints were transfusion requirements, change of coagulation parameters, and adverse events (AEs). One hundred patients (64 m; 36 f; 97 allogeneic; 3 autologous; 67 PBSC; 30 bone marrow; 2 cord blood; 1 unknown) with moderate or severe bleeding were included (38 lower GI; 26 hemorrhagic cystitis; 14 upper GI; 7 pulmonary; 1 intracerebral; 14 other). 80 μg/kg rFVIIa was effective, however no significant reduction in bleeding was seen at 160 μg/kg. There were no differences in transfusion requirements and changes in coagulation parameters across dose groups. Thirteen serious adverse events (SAEs) were reported within the trial period; there was no apparent drug or dose-related trend in the type or number of SAEs. One thromboembolic SAE (catheter thrombosis, 160 μg/kg) was observed within the trial period (2 days after last dosing) and two thromboembolic SAEs (cerebral infarction, 80 μg/kg; myocardial infarction, 40 μg/kg) were reported 4 and 14 days after last dosing. In this first controlled study on the use of rFVIIa after HSCT we found a significant effect of 80 μg/kg rFVII versus the standard hemostatic treatment. The diversity of the hemostatic disturbances and the heterogeneity of the patient population may have contributed to the lack of an increasing effect with increased dose. No safety issues were identified. Further trials with higher numbers of patients should focus upon optimizing the dose regimen of rFVIIa and on severe bleeding complications Bleeding status 38h after initial dose Treatment Gp N Stopped Decreased Unchanged/worse Cumulative odds ratio 97.1% CI p All data based on ITT. p<0.029 considered sig. Overall treatment effect: p=0.003. *Status unknown for 2 pts Placebo 22 5 (23%) 8 (36%) 9 (41%) 1.00 - - 40μg/kg 20 6 (30%) 4 (20%) 10 (50%) 0.94 [0.24; 3.64] 0.923 80μg/kg 26 14 (54%) 7 (27%) 5 (19%) 4.20 [1.05; 16.84] 0.021 160μg/kg 30 4 (13%) 9 (30%) 17 (57%) 0.54 [0.16; 1.83] 0.269 Total 98* 29 (30%) 28 (29%) 41 (42%) - - -

Mycophenolate Mofetil Therapy Is a Steroid Sparing In Childhood and Young Adult Chronic ITP and Evans Syndrome.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1441-1441
Author(s):  
Zaher Naji ◽  
Madhvi Rajpurkar ◽  
Sureyya Savasan ◽  
Roland Chu ◽  
Meera Chitlur ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Side Effects ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Evans Syndrome ◽  
Corticosteroid Administration ◽  
Chronic Itp ◽  
Life Threatening ◽  
The Mean ◽  
Steroid Sparing

Abstract Abstract 1441 Chronic ITP and Evans syndrome are diseases characterized by autoantibody formation with resultant destruction of platelets or both platelets and red blood cells on neutrophils, respectively. Affected patients are at risk of life threatening bleeding complications and/or life threatening anemia. Conventional therapies are often ineffective or transiently effective and have significant toxicity. One of the most commonly used therapeutic strategies employs chronic corticosteroid administration with the attendant weight gain, hypertension, hyperglycemia, bone loss, infection risk, mood changes and protean other undesirable side effects. Mycophenolate Mofetil (MMF) is an immunosuppressive agent with a favorable side effect profile. It is converted to the active metabolite, mycophenolic acid, and interferes with purine metabolism in T-lymphocytes, effectively killing many of these cells and down-regulating autoimmune phenomena. With approval of our local IRB /HIC we retrospectively reviewed the charts of 11 chronic ITP/Evans syndrome patients who had received MMF, all such patients treated at a large urban Children's Hospital. Clinical variables included age, sex, duration of disease, steroid use, IVIG use, Anti-D use, platelet counts, hemoglobin concentrations and reticulocyte percentages. These data were analyzed using paired t-tests, one-sample t-test and descriptive statistics. The 11 patients ranged in age from 9–22 years old, with a mean age of 15 years. The mean time from diagnosis of disease was 41.8 months with a range of 6–95 months. There were 5 female subjects, 6 Evans syndrome patients and 5 with chronic ITP alone. The median platelet count over the 6 months prior to MMF was 70×109/L, (18-223), with a median of 90×109/L with (27-145) during the first 6 months of MMF therapy (p=0.4). In the Evans syndrome group, the mean hemoglobin prior to MMF was 10.9 g/dL, (9.1-14.6), with a mean of 12.1 g/dL, (6.9-16.7) on MMF (p=0.54). Similarly, the mean reticulocyte percentage was 2.7%, (0.5-14) prior to MMF, with a mean of 2.3%, (0.3-8.9) during MMF therapy. The mean total dose of steroids used in the 6 months prior to MMF was 84.2 mg/kg (prednisone equivalent), (11.2-170), compared to 62.2 mg/kg, (0-193.8) on MMF. 9 of 11 patients had reductions in steroid requirement by an average of 49.3% (p=0.0013). During the first 6 months of MMF both IVIG and anti-D usage decreased from total doses for the entire group of 17 and 3 doses to 8 and 1 dose, respectively. None of the patients experienced severe bleeding episodes or side effects more serious than a transient rash while on MMF. These data suggest that MMF may have a role as a steroid sparing therapy in the treatment of chronic ITP and Evans syndrome. Disclosures: Off Label Use: mycophenolate mofetil for ITP Evans syndrome.

Safety and efficacy of retreating follicular non-Hodgkin’s lymphoma (NHL) with 90Y ibritumomab tiuxetan

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17528-17528 ◽  
Author(s):  
J. Shah ◽  
D. Harrough ◽  
W. Saville ◽  
J. Mueh ◽  
J. Lister ◽  
...  
Keyword(s):  
Platelet Count ◽  
Growth Factor ◽  
External Beam Radiotherapy ◽  
Bleeding Complications ◽  
Hematologic Toxicity ◽  
Ibritumomab Tiuxetan ◽  
Safety And Efficacy ◽  
Secondary Myelodysplastic Syndrome ◽  
The Mean ◽  
Mean Time

17528 Background: There is no data regarding safety and efficacy of treating follicular NHL patients with a second course of 90Y ibritumomab tiuxetan (Zevalin). Methods: Patients with follicular NHL who received 2 courses of Zevalin therapy were identified nationally, and data was retrospectively collected. Results: 10 patients (pts) (mean age 62.5 years, 48–91) were identified. Prior to the first Zevalin, all pts received chemotherapy (mean 2.4 courses, 1–5), 3/10 auto-PBSCT, and 4/10 external beam radiotherapy(ebRT). After the initial course of treatment, the mean time to nadir for the anemia was 7.9 weeks (wks)(4–13), neutropenia was 6.7 wks (4–10); and thrombocytopenia was 5.2 wks (4–8). 1 pt required growth factor support and transfusions; 2 had an incomplete recovery of platelet count at 23 and 30 wks (76,000 and 126,000/μl). Hematologic toxicity and grades are in the table below. Prior to the second course of Zevalin 2 pts received ebRT, 1 received 131I tositumomab, and 3 received chemotherapy (1–5 regimens). The median time to the second Zevalin course was 613 days (183–1,300). After the second course of Zevalin, the mean time to nadir for the anemia was 8.2 wks (2–25); neutropenia was 6.7 wks (4–10); and thrombocytopenia was 5.5 wks (4–7). 4/10 pts required growth factor support, 2 required transfusions, 3 had incomplete recovery of platelet count and early progression, 2 pts had a maximum recovery of their platelet count at 29 and 40 wks (143,000 and 144,000/μl). There were no infectious or bleeding complications with either course of Zevalin. No secondary myelodysplastic syndrome or acute leukemia were reported. Conclusions: Retreating patients with follicular NHL with a second course of Zevalin is tolerable with substantial evidence of clinical efficacy. This data warrants further evaluation of Zevalin retreatment in a clinical trial. [Table: see text] [Table: see text]

scholarly journals Efficacy of Olanzapine for High and Moderate Emetogenic Chemotherapy in Children

Children ◽  
2020 ◽  
Vol 7 (9) ◽  
pp. 140
Author(s):  
So Rae Lee ◽  
Su Min Kim ◽  
Min Young Oh ◽  
Jae Min Lee
Keyword(s):  
Young Adults ◽  
Pediatric Patients ◽  
Complete Response ◽  
Emetogenic Chemotherapy ◽  
Controlled Study ◽  
Safety And Efficacy ◽  
Disturbed Sleep ◽  
Children And Young Adults ◽  
The Mean ◽  
Prospective Controlled Study

This study was conducted to investigate the safety and efficacy of olanzapine for high and moderate emetogenic chemotherapy in children and young adults. We retrospectively reviewed the records of pediatric patients (n = 13) with cancer who had been administered olanzapine as an anti-emetic drug (AED) during a high and moderate emetogenic chemotherapy block from January 2018 to March 2020. Patients were administered other prophylactic AEDs according to practice guidelines. The mean age of the patients was 14.1 ± 5.5 years. The total number of chemotherapy cycles was 41. Twenty-one (51.2%) chemotherapy blocks were high emetogenic chemotherapy and 20 (48.8%) blocks were moderate emetogenic chemotherapy. Olanzapine was used for prophylaxis in 20 (48.8%) blocks of chemotherapy and rescue in 21 (51.2%). Of the 41 cycles, a complete response to olanzapine was achieved in 31 (75.6%), partial response in 6 (14.6%), and no response in 4 (9.8%). The mean dose was 0.07 ± 0.04 mg/kg/dose and 2.50 ± 1.37 mg/m2/dose. Adverse effects included somnolence, hyperglycemia, fatigue, and disturbed sleep. Our findings indicate that olanzapine was effective and safe for treating chemotherapy-induced nausea and vomiting in children. A prospective controlled study is needed to confirm these findings.

scholarly journals Safety and Efficacy of Bivalirudin in Diabetic Acute Coronary Syndrome (ACS) Patients Undergoing Percutaneous Coronary Intervention (PCI)

2021 ◽  
Vol 3 (2) ◽  
pp. 93-97
Author(s):  
A.B.M. Golam Mostofa ◽  
Tanjima Parvin ◽  
Mohammad Rayhan Masum Mandal ◽  
Rawnak Afrin ◽  
Syed Ali Ahsan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Major Bleeding ◽  
Coronary Intervention ◽  
Controlled Study ◽  
Small Scale ◽  
Safety And Efficacy ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Hemorrhagic Complications

Objective: To determine and compare the incidence of in-hospital and 30-day hemorrhagic complications and major adverse cardiac events (MACEs) as evidence of safety and efficacy using Bivalirudin versus Heparin in diabetic acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) in a tertiary care cardiac hospital. Background: Prevention of hemorrhagic complications has emerged as a priority in patients undergoing PCI in addition to suppressing thrombotic complications. This goal is challenging to achieve in diabetic ACS patients as DM itself is a prothrombotic state with more pronounced vascular injury response and have a worse outcome after PCI compared with non-diabetic patients. In patients with ACS, Bivalirudin has been shown to result in similar rates of composite ischemia as Heparin plus GPI (GP IIb /IIIa inhibitor), while significantly reducing major bleeding and has received class I recommendation for PCI. Whether Bivalirudin is safe and effective in diabetic ACS patients undergoing PCI, as compared with Heparin (UFH) monotherapy, is unknown. Methods: 218 diabetic ACS patients (age>18 years and ≤ 75 years) who underwent PCI from May 2018 to April 2019 at UCC, BSMMU, Dhaka, Bangladesh were randomly assigned to have UFH or Bivalirudin. Before the guide wire crossed the lesion, 111 patients in the UFH group received a bolus of 70-100 U/kg (targeted activated clotting time, ACT: 200-250 s). 107 patients in the Bivalirudin group received a loading dose of 0.75 mg/kg, followed by an infusion of 1.75 mg/kg/h for up to 4 hours. Dual antiplatelet (DAPT) loading as Aspirin 300 mg plus P2Y12 inhibitors (Clopidogrel 600 mg or Prasugrel 60 mg or Ticagrelor 180 mg) was given in all patients before the procedure. The maintenance dose of DAPT was continued for at least one month and patients were followed telephonically up to 30 days. The outcome measures were in-hospital and 30-day hemorrhagic complications and MACEs [death, MI, target vessel revascularization (TVR) and stroke]. Results: Patients treated with Bivalirudin compared with Heparin had a significantly lower in-hospital incidence of QMI (0% vs. 6%; p=0.03) and major bleeding (0% vs. 7%; p=0.02). However, the incidence of cardiac death, stent thrombosis, TVR were no differences between the groups (p>0.05). There was only one NQMI in the Bivalirudin group as opposed to 8% in the Heparin group in 30 days following stenting (p=0.04). No other adverse effects were found significantly different between groups in 30 days of PCI. Conclusion: In this small scale, prospective, randomized controlled study of diabetic ACS patients undergoing PCI in a single center showed that Bivalirudin is safe and effective as it reduces immediate and short-term hemorrhagic complications as well as MACEs as compared with Heparin.

Efficacy and safety of enoxaparin in unselected patients with ST-segment elevation myocardial infarction

2008 ◽  
Vol 99 (01) ◽  
pp. 150-154 ◽  
Author(s):  
Anselm Gitt ◽  
Claus Jünger ◽  
Timm Bauer ◽  
Tobias Heer ◽  
Oliver Koeth ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Practice ◽  
Unfractionated Heparin ◽  
Odds Ratio ◽  
Randomized Clinical Trials ◽  
Propensity Score Analysis ◽  
Bleeding Complications ◽  
Entire Group ◽  
Severe Bleeding ◽  
Early Reperfusion

SummaryIn randomized clinical trials the low-molecular-weight heparin enoxaparin has been shown to reduce ischemic complications in patients with acute ST elevation myocardial infarction (STEMI) treated with fibrinolysis. Little is known about the use and efficacy of enoxaparin in unselected patients with STEMI in clinical practice. In a retrospective analysis of the prospective ACOS registry we compared the outcomes of patients with STEMI treated with enoxaparin or unfractionated heparin. A total of 6,299 patients with STEMI < 12 hours were included in this analysis, 609 (10%) were treated with enoxaparin and 5,690 (90%) with unfractionated heparin. In the multivariable propensity score analysis enoxaparin was associated with a reduction in the combined endpoint of death and non-fatal reinfarction in the entire group (odds ratio 0.59; 95% CI 0.43–0.80) and the subgroups of patients treated without early reperfusion (odds ratio 0.65, 95% CI 0.43–0.97), fibrinolysis (odds ratio 0.64; 95% CI 0.33–1.26) and primary percutaneous coronary intervention (odds ratio 0.33;95% CI 0.15–0.72).There was no significant increase in severe bleeding complications with enoxaparin (6.5% versus 5.5%, p=0.4). In clinical practice in unselected patients with STEMI treated with or without early reperfusion therapy early treatment with enoxaparin compared to unfractionated heparin is associated with a significant reduction of the combined endpoint of inhospital death and reinfarction without a significant increase in severe bleeding complications.

scholarly journals Understanding the risks of total hip arthroplasty in patients with von Willebrand’s disease

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902096024
Author(s):  
Andrew G. Yun ◽  
Marilena Qutami ◽  
Sean A. Fischer ◽  
Kory B. Dylan Pasko
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Direct Anterior Approach ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease ◽  
Total Hip ◽  
Estimated Blood Loss ◽  
The Mean

Purpose: Patients with von Willebrand’s disease (VWD) have either a qualitative or quantitative deficiency in a key clotting protein called von Willebrand’s factor. Type Ⅰ disease is the most common variant, but its clinical implications in total hip arthroplasty (THA) are unclear. Our purpose is to describe the perioperative impact of VWD in THA. Methods: We retrospectively reviewed a total of 17 primary THAs in 14 patients with type Ⅰ VWD performed between 2008 and 2019. Almost all cases (88%) received tranexamic acid, and most (59%) received DDAVP. All patients had a direct anterior approach (DAA) THA. Results: None of these cases required a blood transfusion. Mean estimated blood loss was 229 mL, and the mean hemoglobin dropped from 13.9 g/dL to 10.2 g/dL. There were no major bleeding complications. After a mean follow-up of 4 years, the mean hip disability and osteoarthritis outcome score, junior (HOOS, JR) was 79, and there were no reoperations or revisions for any cause. Conclusion: Patients with type Ⅰ VWD do not experience severe bleeding with routine chemoprophylaxis combined with DAA THA.

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