Collagen-Induced Platelet Aggregation and Bleeding Time in Adolescent Idiopathic Scoliosis

Udén, Alf; Nilsson, Inga Marie; Willner, Stig

doi:10.3109/17453678008990873

Cited by 23 publications

(11 citation statements)

References 15 publications

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“…Although multifactorial in origin, peri-operative haemorrhage associated with spinal fusion techniques results primarily from disruption of internal vertebral veins, decortication of large areas of bone [18], and instrumentation of the vertebrae. Furthermore, haemostatic abnormalities may increase the risk of bleeding in some patients: consumption coagulopathy, dilution coagulopathy caused by normovolaemic haemodilution [29], reduced factor VII (FVII) levels [18], and abnormal platelet aggregation [34,42,44] have all been cited as possible contributors to an increased haemorrhagic tendency. Finally, inferior vena cava tear is a rare but potentially life-threatening cause of bleeding during surgical intervention [43].…”

Section: Maciej Kolban Ina Balachowska-kosciolek Michal Chmielnickimentioning

confidence: 99%

Recombinant coagulation factor VIIa—a novel haemostatic agent in scoliosis surgery?

Kołban

Bałachowska-Kościołek

Chmielnicki

2005

Eur Spine J

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Spinal fusion surgery in children and adolescents with idiopathic scoliosis is often associated with severe haemorrhage. Recombinant coagulation factor VIIa (rFVIIa) has previously been shown to be an effective haemostatic treatment for severe bleeding associated with a variety of coagulopathic and non-coagulopathic indications. The aim of this retrospective study was to assess the safety and haemostatic efficacy of rFVIIa in a series of 26 consecutive adolescent patients with scoliosis (22 females; mean age 16.6 years) undergoing correctional surgery. A second series of 26 consecutive patients (20 females; mean age 16.2 years) who received standard therapy during surgery, represented historical controls. Blood loss, transfusion requirements, duration of surgery, and peri-operative measurements of coagulation parameters were compared between the two groups. Intra-operative and combined intra-operative and post-operative blood losses were significantly smaller in the rFVIIa-treatment group than in the historical controls (P=0.003 and 0.032, respectively); rFVIIa-treated patients also demonstrated significantly reduced blood loss per vertebral segment fused (P=0.032) and per hour of surgery (P<0.001). Intra-operative requirements for packed red blood cells were also significantly lower in the treatment group (P=0.042). Patients in the treatment group demonstrated rapid and maintained reduction of prothrombin time and international normalised ratio; values among rFVIIa-treated patients remained significantly lower than those in the control group at all time points evaluated (P<0.001). There were no deaths and no adverse events. These results suggest that rFVIIa is a safe and effective haemostatic agent for use during spinal fusion surgery in adolescent patients with idiopathic scoliosis; however, further research and randomised, placebo-controlled trials are needed to confirm these findings.

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Section: Maciej Kolban Ina Balachowska-kosciolek Michal Chmielnickimentioning

confidence: 99%

Recombinant coagulation factor VIIa—a novel haemostatic agent in scoliosis surgery?

Kołban

Bałachowska-Kościołek

Chmielnicki

2005

Eur Spine J

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“…Abnormal bleeding times have been reported in a variety of disorders not thought of as primarily platelet-related (the degree to which these disorders may prolong the bleeding time on the basis of altered platelet count, mass, or efficacy is not estab lished). The list of diseases includes amyloidosis; 139 Barrier's syndrome; 140 glycogen storage disease type I; 141 congenital heart disease; 73,97,142,143 diseases af fecting tissue integrity, such as scoliosis 35,144,145 and collagen defects 146 (including osteogenesis imperfecta 147,148 and Ehlers-Danlos syndrome 149 ); neurofibromatosis, 3 dysfibrinogenemia; 150 defi ciencies of fibrinogen [151][152][153] or coagulation Factors V, [154][155][156][157] VII, [158][159][160][161] VIII, 5,22,98,157,[162][163][164][165][166][167][168][169][170][171] IX, 98,157,166,168,169,[172]…”

Section: The Bleeding Time Is Not a Specific In Vivo Indicator Of Plamentioning

confidence: 99%

A Critical Reappraisal of the Bleeding Time*

Rodgers¹,

Levin²

1990

Semin Thromb Hemost

612

292

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Since its initial invention by the French worker Milian in 1901, the bleeding time has been put forward as a clinically useful test in three contexts: diagnosis (particularly of platelet disorders), prediction of clinically important bleeding, and assessment of the adequacy of various forms of therapy. Attempting a complete review of the published experience with this test, we assessed 862 articles. Original bleeding time data appeared in 664 of these articles, from which we tabulated 1083 distinct studies in humans. ROC analysis, which characterizes the sensitivity and specificity of the test, was applied in every instance in which published data were adequate (34 studies). ROCs from 27 studies of the bleeding time in association with aspirin ingestion reveal high variability in the ability of the bleeding time to detect aspirin intake, and provide evidence against claims that recently devised bleeding time methods have improved discriminatory ability based on improved reproducibility. Two ROCs from surgical studies, in which the bleeding time was used to try to predict abnormal bleeding, were statistically indistinguishable from that of a completely noninformative test. In ROCs from five studies of abnormal bleeding in uremia, the test performed approximately the same as the platelet count or hematocrit (taken singly); in one of these studies, prothrombin consumption was determined and was a better predictor of bleeding than bleeding time, hematocrit, or platelet count. In the settings of renal biopsy (one study) and massive transfusion (one study), data allowed estimation of predictive value: in no instance was there evidence that the bleeding time significantly altered a priori estimates (based on prevalence) of the risk of bleeding. Linear regression analysis was applied to data from 23 studies relating platelet count to bleeding time, to assess published claims that the bleeding time and platelet count follow a predictively useful linear relationship. In 22 of 23 instances, the inverse relationship between bleeding time and platelet count was associated with broad statistical scatter, making it impossible to predict precisely one variable given the other. The pathophysiology of an abnormal bleeding time remains poorly understood. The bleeding time is affected by a large number of diseases, drugs, physiologic factors, test conditions, and therapeutic actions, not all of them platelet-related. The test is likely to remain widely used for the diagnosis of inherited disorders of platelet function, such as von Willebrand's syndrome, despite the lack of clear criteria for its use in this context.(ABSTRACT TRUNCATED AT 400 WORDS)

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“…It has also been reported that platelets from healthy donors do not aggregate normally in response to collagen from patients with AIS, which suggests an underlying collagen abnormality [10]. Although a defect of collagen may contribute to the increased risk of bleeding in patients with AIS, it is unclear how this could account for the coagulation factor deficiencies or platelet function abnormalities observed in our study.…”

Section: Results Of Coagulation and Platelet Function Testing In Patimentioning

confidence: 44%

High prevalence of abnormal preoperative coagulation tests in patients with adolescent idiopathic scoliosis

Baccala

Thom

et al. 2005

Journal of Thrombosis and Haemostasis

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Collagen-Induced Platelet Aggregation and Bleeding Time in Adolescent Idiopathic Scoliosis

Cited by 23 publications

References 15 publications

Recombinant coagulation factor VIIa—a novel haemostatic agent in scoliosis surgery?

Recombinant coagulation factor VIIa—a novel haemostatic agent in scoliosis surgery?

A Critical Reappraisal of the Bleeding Time*

High prevalence of abnormal preoperative coagulation tests in patients with adolescent idiopathic scoliosis

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