Abstract Number: PB0951
Meeting: ISTH 2021 Congress
Background: Von Willebrand disease (vWD) is the most common inherited bleeding disorder.
Optimal surgical management for these patients is dependent on multiple factors (type of surgery, type of vWD, baseline von Willebrand factor (vWF) and factor VIII (FVIII) levels, patient’s history of bleeding).
Currently, consensus on the preferred surgical management for all patients is lacking and many of the recommendations regarding the use of replacement therapy are based on expert opinion.
Aims: Describing prophylaxis in a patient with vWD for a neurosurgery.
Methods: Review a clinical case.
Results: A 49-year-old woman with vWD type 2N was submitted to a meningioma resection under replenishment with recombinant FVIII concentrate (rcFVIII).
Screening coagulation tests pre-surgery showed: Prothrombin Time (PT) 11.9″; activated Partial Thromboplastin Time (aPTT) 31.3″; Fib. 345 mg/dL; vWF:Ag 209; vWF:Act 224; FVIII 43.8%.
Two hours before surgery she received 2000 IU of rcFVIII and tranexamic acid.
Seven hours after administering the rcFVIII we have measured FVIII (67.6%).
Approximately ten hours after surgery, she did not have hemorrhagic complications. We administered additional 1000 IU of rcFVIII.
Twenty hours after surgery, CT scan was performed that showed only small acute hemorrhagic foci.
In D1 post-surgery, she initiated replacement treatment with rcFVIII every 12 hours.
In D3 post-surgery, twelve hours after administering the rcFVIII: FVIII 85.9%.
After D4 post-surgery, she maintained replacement treatment with rcFVIII 1000UI each day.
In D7 post-surgery, twenty-four hours after administering the rcFVIII: aPTT 29.3″; vWF:Ag 262; vWF:Act 232; FVIII 59.9%. An MRI was performed without showing hemorrhages.
In D11 post-surgery, due to maintaining adequate hemostatic values, factor administration was reduced to every other day until D15 post-surgery.
Conclusions: Patients with vWD might have an increased risk of bleeding-related complications, particularly during and after surgery.
It is highly recommended that any surgery should be managed by a specialized and experienced multidisciplinary team.
To cite this abstract in AMA style:Cabral J, Calaza C, Calheiros M, Marques A. Neurosurgery in a Patient with von Willebrand Disease: A Case-report [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/neurosurgery-in-a-patient-with-von-willebrand-disease-a-case-report/. Accessed December 2, 2022.
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