Abstract Number: PB0705
Meeting: ISTH 2021 Congress
Background: There is a lack of data on the occurrence of re-bleeding after hemostatic challenges in patients with mild bleeding disorders (MBDs) or bleeding of unknown cause (BUC).
Aims: To investigate re-bleeding rates and risk factors for re-bleeding in patients with MBD or BUC, who underwent surgery, tooth extraction or childbirth.
Methods: 253 of 639 patients with a mild bleeding tendency (39.6%), who were included in the Vienna bleeding biobank (VIBB, EC: 603/2009, Gebhart et al. JTH. 2018) were available for a follow-up to record re-bleeding rates after hemostatic challenges using a standardized questionnaire.
Results: Of the 253 patients, 95 (37.5%) had a MBD and 158 (62.5%) were BUC patients. The mean (standard deviation, SD) age, bleeding score (BS) at study inclusion, and time to follow-up of the patients were 44.7 (15.9) years, 6.0 (3.2), and 36.0 (19.2) months.
At follow-up, 23/74 (31.1 %) patients had a re-bleeding after surgery, 13/28 (46.4%) after tooth extraction, and 1/3 (33.3%) woman had a re-bleeding after childbirth (Table 1). Patients with bleeding after surgery and tooth extraction at study inclusion had a significant increased risk for re-bleeding of the same manifestation (Table 1). There was no difference between patients with MBD or BUC (data not shown).
|Symptom||Total||Bleeding at inclusion||Re-Bleeding at FU||No bleeding at inclusion||Bleeding at FU||p*||BHC|
|N||N||n (%)||N||n (%)|
|Postsurgical bleeding†||110||74||23 (31.1)||36||2 (5.1)||0.003||<.05|
|Bleeding after tooth extraction†||55||28||13 (46.4)||27||3 (11.1)||0.004||<.05|
|Postpartum bleeding §||17||3||1 (33.3)||14||1 (7.1)||0.331||ns|
|† including patients, who had surgery or tooth extraction in the follow-up period, respectively
§ including all women who gave birth in the follow-up period
FU, follow-up; BHC, Bonferroni-Holm-correction; * χ2 test or Fisher’s exact
In multivariable analysis, a higher BS at baseline and blood group O were independent risk factors for re-bleeding in patients with hemostatic challenges (Table 2).
|Unit||OR||95% CI||p||OR||95% CI||p|
|Sex||Female vs. male||3.18||0.90-11.21||0.072||3.33||0.89-12.43||0.074|
|Vicenza BS at baseline||1.0||1.18||1.06-1.31||0.003||1.16||1.03-1.31||0.015|
|ABO blood group||O vs. non-O||3.02||1.39-6.67||0.005||3.45||1.52-7.81||0.003|
|Diagnosis||non-BUC vs. BUC||1.34||0.65-2.75||0.426|
|Positive family history||No vs. yes||0.57||0.27-1.19||0.131|
|Follow up time||1.0 year||0.88||0.70-1.11||0.278|
Conclusions: Patients with a mild to moderate bleeding tendency with previous bleeding after invasive procedures have a significant risk for re-bleeding, independent of a diagnosis of a bleeding disorder, especially in patients with blood group O and a high bleeding score at inclusion. These findings encourage prophylactic treatment when patients face hemostatic challenges such as surgery or tooth extractions.
To cite this abstract in AMA style:Mehic D, Neubauer G, Kaider A, Ay C, Pabinger I, Gebhart J. Increased Risk for Re-bleeding after Hemostatic Challenges in Patients with a Mild to Moderate Bleeding Tendency [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/increased-risk-for-re-bleeding-after-hemostatic-challenges-in-patients-with-a-mild-to-moderate-bleeding-tendency/. Accessed September 24, 2021.
« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/increased-risk-for-re-bleeding-after-hemostatic-challenges-in-patients-with-a-mild-to-moderate-bleeding-tendency/