Post‐tonsillectomy bleeding in children with von Willebrand disease: A single‐institution experience

Abstract

Objectives-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 posttonsillectomy bleeding in children with and without vWD.Study Design-Historical cohort study.Setting-Tertiary care, university-based pediatric hospital.Subjects and Methods-Medical records were examined for 99 patients with vWD and 99 patients without vWD under the age of 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 8 of 99 (8 percent) vWD patients and in 6 of 99 (6 percent) 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 8 children with vWD and 2 of 6 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 to non-vWD patients. No significant difference in the number of bleeding events was noted based on 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.

Haemorrhagic complications with adenotonsillectomy in children and young adults with bleeding disorders

“…A recent report by Venkatesan et al [5] found no increased risk of POH in a cohort of 14 patients with haematological abnormalities (red blood cell, platelet, or coagulation disorders) similar to the report by Rodriguez et al [6] who studied 99 patients with vWD. A recent report by Venkatesan et al [5] found no increased risk of POH in a cohort of 14 patients with haematological abnormalities (red blood cell, platelet, or coagulation disorders) similar to the report by Rodriguez et al [6] who studied 99 patients with vWD.…”

Haemostasis prophylaxis using single dose desmopressin acetate and extended use epsilon aminocaproic acid for adenotonsillectomy in patients with type 1 von Willebrand disease

“…Finally, Rodriguez et al. [8] compared the rates of post‐tonsillectomy bleeding in 198 paediatric patients with or without VWD. A single preoperative dose of DDAVP was administered to 90/99 (91%) VWD patients, (70% with type 1), among whom 46/99 received EACA for an unspecified postoperative period.…”

Significance of advanced haemostasis investigation in recurrent, severe post-tonsillectomy bleeding

“…1,2 It is thus one of the most commonly performed surgical procedures. 3 In particular, tonsillectomy and/or adenoidectomy is the most common elective surgical procedure among US children, being performed in 300 000 patients every year.…”