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Bleeding risk of surgery and its prevention in patients with inherited platelet disorders

Excessive bleeding at surgery is a feared complication in patients with inherited platelet disorders. However, very few studies have evaluated the frequency of surgical bleeding in these hemorrhagic disorders. We performed a worldwide, multicentric, retrospective study to assess the bleeding complic...

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Autores principales: Orsini, Sara, Noris, Patrizia, Bury, Loredana, Heller, Paula G., Santoro, Cristina, Kadir, Rezan A., Butta, Nora C., Falcinelli, Emanuela, Cid, Ana Rosa, Fabris, Fabrizio, Fouassier, Marc, Miyazaki, Koji, Lozano, Maria Luisa, Zúñiga, Pamela, Flaujac, Claire, Podda, Gian Marco, Bermejo, Nuria, Favier, Remi, Henskens, Yvonne, De Maistre, Emmanuel, De Candia, Erica, Mumford, Andrew D., Ozdemir, Gul Nihal, Eker, Ibrahim, Nurden, Paquita, Bayart, Sophie, Lambert, Michele P., Bussel, James, Zieger, Barbara, Tosetto, Alberto, Melazzini, Federica, Glembotsky, Ana C., Pecci, Alessandro, Cattaneo, Marco, Schlegel, Nicole, Gresele, Paolo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Ferrata Storti Foundation 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566025/
https://www.ncbi.nlm.nih.gov/pubmed/28385783
http://dx.doi.org/10.3324/haematol.2016.160754
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author Orsini, Sara
Noris, Patrizia
Bury, Loredana
Heller, Paula G.
Santoro, Cristina
Kadir, Rezan A.
Butta, Nora C.
Falcinelli, Emanuela
Cid, Ana Rosa
Fabris, Fabrizio
Fouassier, Marc
Miyazaki, Koji
Lozano, Maria Luisa
Zúñiga, Pamela
Flaujac, Claire
Podda, Gian Marco
Bermejo, Nuria
Favier, Remi
Henskens, Yvonne
De Maistre, Emmanuel
De Candia, Erica
Mumford, Andrew D.
Ozdemir, Gul Nihal
Eker, Ibrahim
Nurden, Paquita
Bayart, Sophie
Lambert, Michele P.
Bussel, James
Zieger, Barbara
Tosetto, Alberto
Melazzini, Federica
Glembotsky, Ana C.
Pecci, Alessandro
Cattaneo, Marco
Schlegel, Nicole
Gresele, Paolo
author_facet Orsini, Sara
Noris, Patrizia
Bury, Loredana
Heller, Paula G.
Santoro, Cristina
Kadir, Rezan A.
Butta, Nora C.
Falcinelli, Emanuela
Cid, Ana Rosa
Fabris, Fabrizio
Fouassier, Marc
Miyazaki, Koji
Lozano, Maria Luisa
Zúñiga, Pamela
Flaujac, Claire
Podda, Gian Marco
Bermejo, Nuria
Favier, Remi
Henskens, Yvonne
De Maistre, Emmanuel
De Candia, Erica
Mumford, Andrew D.
Ozdemir, Gul Nihal
Eker, Ibrahim
Nurden, Paquita
Bayart, Sophie
Lambert, Michele P.
Bussel, James
Zieger, Barbara
Tosetto, Alberto
Melazzini, Federica
Glembotsky, Ana C.
Pecci, Alessandro
Cattaneo, Marco
Schlegel, Nicole
Gresele, Paolo
author_sort Orsini, Sara
collection PubMed
description Excessive bleeding at surgery is a feared complication in patients with inherited platelet disorders. However, very few studies have evaluated the frequency of surgical bleeding in these hemorrhagic disorders. We performed a worldwide, multicentric, retrospective study to assess the bleeding complications of surgery, the preventive and therapeutic approaches adopted, and their efficacy in patients with inherited platelet disorders: the Surgery in Platelet disorders And Therapeutic Approach (SPATA) study. We rated the outcome of 829 surgical procedures carried out in 423 patients with well-defined forms of inherited platelet disorders: 238 inherited platelet function disorders and 185 inherited platelet number disorders. Frequency of surgical bleeding was high in patients with inherited platelet disorders (19.7%), with a significantly higher bleeding incidence in inherited platelet function disorders (24.8%) than in inherited platelet number disorders (13.4%). The frequency of bleeding varied according to the type of inherited platelet disorder, with biallelic Bernard Soulier syndrome having the highest occurrence (44.4%). Frequency of bleeding was predicted by a pre-operative World Health Organization bleeding score of 2 or higher. Some types of surgery were associated with a higher bleeding incidence, like cardiovascular and urological surgery. The use of pre-operative pro-hemostatic treatments was associated with a lower bleeding frequency in patients with inherited platelet function disorders but not in inherited platelet number disorders. Desmopressin, alone or with antifibrinolytic agents, was the preventive treatment associated with the lowest bleedings. Platelet transfusions were used more frequently in patients at higher bleeding risk. Surgical bleeding risk in inherited platelet disorders is substantial, especially in inherited platelet function disorders, and bleeding history, type of disorder, type of surgery and female sex are associated with higher bleeding frequency. Prophylactic pre-operative pro-hemostatic treatments appear to be required and are associated with a lower bleeding incidence.
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spelling pubmed-55660252017-09-07 Bleeding risk of surgery and its prevention in patients with inherited platelet disorders Orsini, Sara Noris, Patrizia Bury, Loredana Heller, Paula G. Santoro, Cristina Kadir, Rezan A. Butta, Nora C. Falcinelli, Emanuela Cid, Ana Rosa Fabris, Fabrizio Fouassier, Marc Miyazaki, Koji Lozano, Maria Luisa Zúñiga, Pamela Flaujac, Claire Podda, Gian Marco Bermejo, Nuria Favier, Remi Henskens, Yvonne De Maistre, Emmanuel De Candia, Erica Mumford, Andrew D. Ozdemir, Gul Nihal Eker, Ibrahim Nurden, Paquita Bayart, Sophie Lambert, Michele P. Bussel, James Zieger, Barbara Tosetto, Alberto Melazzini, Federica Glembotsky, Ana C. Pecci, Alessandro Cattaneo, Marco Schlegel, Nicole Gresele, Paolo Haematologica Article Excessive bleeding at surgery is a feared complication in patients with inherited platelet disorders. However, very few studies have evaluated the frequency of surgical bleeding in these hemorrhagic disorders. We performed a worldwide, multicentric, retrospective study to assess the bleeding complications of surgery, the preventive and therapeutic approaches adopted, and their efficacy in patients with inherited platelet disorders: the Surgery in Platelet disorders And Therapeutic Approach (SPATA) study. We rated the outcome of 829 surgical procedures carried out in 423 patients with well-defined forms of inherited platelet disorders: 238 inherited platelet function disorders and 185 inherited platelet number disorders. Frequency of surgical bleeding was high in patients with inherited platelet disorders (19.7%), with a significantly higher bleeding incidence in inherited platelet function disorders (24.8%) than in inherited platelet number disorders (13.4%). The frequency of bleeding varied according to the type of inherited platelet disorder, with biallelic Bernard Soulier syndrome having the highest occurrence (44.4%). Frequency of bleeding was predicted by a pre-operative World Health Organization bleeding score of 2 or higher. Some types of surgery were associated with a higher bleeding incidence, like cardiovascular and urological surgery. The use of pre-operative pro-hemostatic treatments was associated with a lower bleeding frequency in patients with inherited platelet function disorders but not in inherited platelet number disorders. Desmopressin, alone or with antifibrinolytic agents, was the preventive treatment associated with the lowest bleedings. Platelet transfusions were used more frequently in patients at higher bleeding risk. Surgical bleeding risk in inherited platelet disorders is substantial, especially in inherited platelet function disorders, and bleeding history, type of disorder, type of surgery and female sex are associated with higher bleeding frequency. Prophylactic pre-operative pro-hemostatic treatments appear to be required and are associated with a lower bleeding incidence. Ferrata Storti Foundation 2017-07 /pmc/articles/PMC5566025/ /pubmed/28385783 http://dx.doi.org/10.3324/haematol.2016.160754 Text en Copyright© 2017 Ferrata Storti Foundation Material published in Haematologica is covered by copyright. All rights are reserved to the Ferrata Storti Foundation. Use of published material is allowed under the following terms and conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode. Copies of published material are allowed for personal or internal use. Sharing published material for non-commercial purposes is subject to the following conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode, sect. 3. Reproducing and sharing published material for commercial purposes is not allowed without permission in writing from the publisher.
spellingShingle Article
Orsini, Sara
Noris, Patrizia
Bury, Loredana
Heller, Paula G.
Santoro, Cristina
Kadir, Rezan A.
Butta, Nora C.
Falcinelli, Emanuela
Cid, Ana Rosa
Fabris, Fabrizio
Fouassier, Marc
Miyazaki, Koji
Lozano, Maria Luisa
Zúñiga, Pamela
Flaujac, Claire
Podda, Gian Marco
Bermejo, Nuria
Favier, Remi
Henskens, Yvonne
De Maistre, Emmanuel
De Candia, Erica
Mumford, Andrew D.
Ozdemir, Gul Nihal
Eker, Ibrahim
Nurden, Paquita
Bayart, Sophie
Lambert, Michele P.
Bussel, James
Zieger, Barbara
Tosetto, Alberto
Melazzini, Federica
Glembotsky, Ana C.
Pecci, Alessandro
Cattaneo, Marco
Schlegel, Nicole
Gresele, Paolo
Bleeding risk of surgery and its prevention in patients with inherited platelet disorders
title Bleeding risk of surgery and its prevention in patients with inherited platelet disorders
title_full Bleeding risk of surgery and its prevention in patients with inherited platelet disorders
title_fullStr Bleeding risk of surgery and its prevention in patients with inherited platelet disorders
title_full_unstemmed Bleeding risk of surgery and its prevention in patients with inherited platelet disorders
title_short Bleeding risk of surgery and its prevention in patients with inherited platelet disorders
title_sort bleeding risk of surgery and its prevention in patients with inherited platelet disorders
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566025/
https://www.ncbi.nlm.nih.gov/pubmed/28385783
http://dx.doi.org/10.3324/haematol.2016.160754
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