Abstract Number: PB0705
Meeting: ISTH 2021 Congress
Theme: Hemophilia and Rare Bleeding Disorders » Rare Bleeding Disorders
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).
Univariate | Multivariable | ||||||
---|---|---|---|---|---|---|---|
Unit | OR | 95% CI | p | OR | 95% CI | p | |
Age | 10.0 years | 1.00 | 0.79-1.26 | 0.964 | 0.89 | 0.68-1.16 | 0.379 |
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 2). https://abstracts.isth.org/abstract/increased-risk-for-re-bleeding-after-hemostatic-challenges-in-patients-with-a-mild-to-moderate-bleeding-tendency/. Accessed March 22, 2024.« 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/