Spinal Anesthesia for Cesarean Delivery in a Woman With Type-2M von Willebrand Disease: Case Report and Mini-review

Cata, Juan P.; Hanna, Ameen Abu; Tetzlaff, John E.; Bishai, A.; Barsoum, Sabri

doi:10.1097/01.aoa.0000386860.28772.7d

Cited by 1 publication

(4 citation statements)

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“…Patients in some studies received treatment with desmopressin or VWF/factor VIII concentrates before administration of neuraxial anesthesia; however, important details were missing from each. Authors either did not specify which patients received treatment 92 or they did not publish a replacement target 82,83,85,86 . Overall, neuraxial anesthesia was performed at VWF levels ranging from 10 IU/dL 13 to 198 IU/dL 83 and factor VIII levels ranging from 38 IU/dL 13 to 249 IU/dL 84 without bleeding complications.…”

Section: Resultsmentioning

confidence: 99%

“…Six case reports/case series, [81][82][83][84][85][86] one prospective cohort study, 90 and three retrospective cohort studies 79,91,92 were reviewed, which described 134 neuraxial anesthetic procedures without any reported spinal or epidural hematoma. Fifteen epidural procedures, [82][83][84]92 , two spinal anesthetics, 85,86 and one combined spinal-epidural 81 were reviewed. The remaining 116 procedures were performed in studies reporting a mixture of both spinal and epidural anesthetics.…”

Section: Von Willebrand Diseasementioning

confidence: 99%

“…We identified 19 studies relating to neuraxial anesthesia in patients with VWD. 13,17,18,63,64,77,79,[81][82][83][84][85][86][87][88][89][90][91][92] Of the 19 studies, 5 described patients with type 1 VWD, 81,83,84,86,90 and 2 described patients with type 2 VWD, 82,85 while the remainder did not specify the subtype.…”

Section: Von Willebrand Diseasementioning

confidence: 99%

“…82,83,85,86 Overall, neuraxial anesthesia was performed at VWF levels ranging from 10 IU/dL 13 to 198 IU/ dL83 and factor VIII levels ranging from 38 IU/dL 13 to 249 IU/dL 84 without bleeding complications. Only one study reported VWF and factor VIII levels at time of neuraxial catheter removal: 136 IU/dL and 100 IU/dL, respectively 83.…”

mentioning

confidence: 99%

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Evaluating hemostatic thresholds for neuraxial anesthesia in adults with hemorrhagic disorders and tendencies: A scoping review

Peterson

Tse

Martin

et al. 2021

Research and Practice in Thrombosis and Haemostasis

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Neuraxial anesthesia can be complicated by spinal or epidural hematoma and may result in permanent neurologic injury. There is a paucity of literature characterizing this serious complication in patients with congenital and acquired hemorrhagic disorders or tendencies. The objective of this scoping review was to describe the hemostatic laboratory parameters where neuraxial anesthesia has been administered with and without spinal and epidural hematoma in patients with preexisting hemorrhagic disorders and tendencies, including immune thrombocytopenia, gestational thrombocytopenia, thrombocytopenia associated with hypertensive disorders of pregnancy, platelet function disorders, von Willebrand disease, coagulation factor deficiencies, and fibrinogen disorders. A systematic search of Ovid MEDLINE, CINAHL, Embase, Scopus, and Web of Science was performed. Two authors independently reviewed all titles, abstracts, and full texts to determine study eligibility and extract data. Qualitative synthesis of 91 studies revealed significant gaps in our understanding of the risk of spinal and epidural hematoma in patients with hemorrhagic disorders and tendencies, including few studies of males and in nonobstetric settings. Most reviewed articles were small, retrospective studies at high risk for potential bias. With such low‐quality data, we were unable to provide any true estimates of the risk of spinal or epidural hematoma for these patients, nor could we attribute any specific hemostatic or laboratory values to increased risk of hematoma. There is a need both for larger and more rigorously designed and reported studies on this subject and for structured, comprehensive recommendations for safe administration and removal of neuraxial anesthesia in patients with hemorrhagic disorders and tendencies.

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