Posttonsillectomy Hemorrhage in Children With von Willebrand Disease or Hemophilia

Sun, Gordon H.; Auger, Katherine A.; Aliu, Oluseyi; Patrick, Stephen W.; DeMonner, Sonya; Davis, Matthew M.

doi:10.1001/jamaoto.2013.1821

Cited by 23 publications

(19 citation statements)

References 26 publications

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“…528 Further evidence of the safety and efficacy of surgical procedures comes from reviews of surgical outcomes in children with IBDs. [529][530][531] The most frequent interventions are circumcision, dental procedures, insertion of central venous access devices and tonsillectomy.…”

Section: General Perioperative Management Recommendationsmentioning

confidence: 99%

“…However, delayed haemorrhage occurred in 15%, substantially higher than the 1 to 3% reported in healthy patients. 530 Small case series studies in children with IBDs undergoing adenotonsillar procedures report variable rates of haemorrhage: lower, 532-535 similar, 536,537 or higher 538 than in healthy patients. These data suggest that perioperative protocols could be improved to reduce bleeding risk further.…”

Section: General Perioperative Management Recommendationsmentioning

confidence: 99%

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Management of severe perioperative bleeding

Kozek‐Langenecker

Ahmed

Afshari

et al. 2017

European Journal of Anaesthesiology

694

316

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: The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide healthcare professionals with an overview of the most recent evidence to help ensure improved clinical management of patients. For this update, electronic databases were searched without language restrictions from 2011 or 2012 (depending on the search) until 2015. These searches produced 18 334 articles. All articles were assessed and the existing 2013 guidelines were revised to take account of new evidence. This update includes revisions to existing recommendations with respect to the wording, or changes in the grade of recommendation, and also the addition of new recommendations. The final draft guideline was posted on the European Society of Anaesthesiology website for four weeks for review. All comments were collated and the guidelines were amended as appropriate. This publication reflects the output of this work.

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Section: General Perioperative Management Recommendationsmentioning

confidence: 99%

Section: General Perioperative Management Recommendationsmentioning

confidence: 99%

Management of severe perioperative bleeding

Kozek‐Langenecker

Ahmed

Afshari

et al. 2017

European Journal of Anaesthesiology

694

316

View full text Add to dashboard Cite

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“…Previous reports indicated that bleeding rates in children with known coagulopathies are between 2% and 17% [5][6][7][8]. Sun et al [7] reported that the rate of delayed hemorrhage after tonsillectomy in children with VWD or hemophilia was much higher, especially in older children. Considering all the relevant factors including the patient's condition, laboratory tests, the type of surgery, and the NHLBI recommendations [3], we followed the pediatrician's instructions.…”

Section: Discussionmentioning

confidence: 99%

“…Tonsillectomy is not a major surgery, but there is a high risk of bleeding during and after the procedure [4]. Previous reports indicated that bleeding rates in children with known coagulopathies are between 2% and 17% [5][6][7][8]. Sun et al [7] reported that the rate of delayed hemorrhage after tonsillectomy in children with VWD or hemophilia was much higher, especially in older children.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative management of a pediatric patient with suspected type 1 von Willebrand disease undergoing tonsillectomy: a case report

et al. 2019

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Background: Von Willebrand disease (VWD) is the most common inherited bleeding disorder in humans. Coagulopathies such as VWD are evidently risk factors for post-surgical bleeding. Perioperative management of patients with VWD remains controversial and is a major clinical concern. Case presentation: A 5-year-old girl was scheduled for tonsillectomy under general anesthesia. Preoperative laboratory tests revealed prolongation of activated partial thromboplastin time and a mild decrease in von Willebrand factor (VWF) activity. Prophylactic administration of desmopressin or VWF was not performed. During tonsillectomy, oozing from the surgical wound was uncontrollable by conventional hemostasis techniques, but complete hemostasis was ensured by plasma-derived coagulation factor VIII concentrate containing VWF. Conclusion: Pediatric patients with mild abnormalities in preoperative laboratory tests may have coagulopathies. Prophylactic intervention and/or the preparation of a sufficient amount of coagulation factor VIII concentrate containing VWF may be required in patients suspected of having VWD or with mild VWF deficiency.

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Association Between Ibuprofen Use and Severity of Surgically Managed Posttonsillectomy Hemorrhage

Mudd

Thottathil

Giordano

et al. 2017

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Ibuprofen used in postoperative management of pain after tonsillectomy has not been shown to increase the overall risk for posttonsillectomy hemorrhage (PTH). The severity of bleeding is difficult to quantify but may be a more important outcome to measure. OBJECTIVE To evaluate the association between ibuprofen use and severity of PTH using transfusion events as a marker of severity. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study identified 8868 patients who underwent tonsillectomy from January 20, 2011, through June 30, 2014, at the tertiary academic Children's Hospital of Philadelphia. Of these patients, 6710 met the inclusion criteria. Data were collected using electronic database acquisition and query. MAIN OUTCOMES AND MEASURES Multivariate analysis was performed to identify independent prognostic factors for PTH and receipt of transfusion. RESULTS Of the 6710 patients who met criteria for analysis (3454 male [51.5%] and 3256 female [48.5%]; median age, 5.4 years [interquartile range, 3.7-8.2 years]), 222 (3.3%) presented with PTH that required surgical control (sPTH). A total of 15 of the 8868 patients required transfusion for an overall risk for transfusion after tonsillectomy of 0.2%. Fifteen of 222 patients undergoing sPTH (6.8%) received transfusions. No significant independent increased risk for sPTH was associated with use of ibuprofen (adjusted odds ratio [OR], 0.90; 95% CI, 0.68-1.19). A significant independent association was found in the risk for sPTH in patients 12 years or older (adjusted OR, 2.74; 95% CI, 1.99-3.76) and in patients with a history of recurrent tonsillitis (adjusted OR, 1.52; 95% CI, 1.12-2.06). When using transfusion rates as a surrogate for severity of sPTH, transfusion increased by more than 3-fold among ibuprofen users compared with nonusers (adjusted OR, 3.16; 95% CI, 1.01-9.91), and the upper limit of the 95% CI suggests the difference could be nearly 10 times greater. CONCLUSIONS AND RELEVANCE The risk for sPTH is not increased with use of postoperative ibuprofen but is increased in patients 12 years or older and patients undergoing tonsillectomy with a history of recurrent tonsillitis. Hemorrhage severity is significantly increased with ibuprofen use when using transfusion rate as a surrogate marker for severity.

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Posttonsillectomy Hemorrhage in Children With von Willebrand Disease or Hemophilia

Abstract: The frequency of immediate posttonsillectomy hemorrhage in children with VWD or hemophilia is similar to rates in the general healthy population. However, among children with VWD or hemophilia, the rate of delayed hemorrhage is substantially higher, especially in older children.

Cited by 23 publications

References 26 publications

Management of severe perioperative bleeding

Management of severe perioperative bleeding

Perioperative management of a pediatric patient with suspected type 1 von Willebrand disease undergoing tonsillectomy: a case report

Association Between Ibuprofen Use and Severity of Surgically Managed Posttonsillectomy Hemorrhage

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