Prophylactic and therapeutic strategies for intraoperative bleeding in women with von Willebrand disease and heavy menstrual bleeding: A systematic review

IF 6.9 2区医学 Q1 HEMATOLOGY

Blood Reviews Pub Date : 2023-11-01 DOI:10.1016/j.blre.2023.101131

H.P. Eising , M.C. Punt , J.C. Leemans , M.Y. Bongers

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Abstract

Background

Optimal peri-operative management for women with Von Willebrand disease (VWD) and heavy menstrual bleeding (HMB) remains undetermined.

Aim and methods

To evaluate (pre)operative management in relation to (post)operative bleeding after endometrial ablation (EA) and hysterectomy in VWD women with HMB by performing a database search between 1994 and 2023.

Results

Eleven cohort studies and 1 case-report were included, of overall ‘low’ quality, describing 691 operative procedures. Prophylaxis (Desmopressin, clotting factor concentrates or tranexamic acid) to prevent bleeding was described in 100% (30/30) of EA procedures and in 4% (24/661) of hysterectomies. Bleeding complications despite prophylaxis were described in 13% (3/24) of hysterectomies vs 0% (0/30) in EA.

Conclusion

VWD women often seem to experience bleeding complications during hysterectomy and all women with VWD received preprocedural hemostatic agents during EA, indicating potential under- and overdosing of current prophylactic strategies. Prospective studies are needed to determine the optimal (pre)operative strategy for gynecological surgical procedures in women with VWD.

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血管性血友病合并大量月经出血妇女术中出血的预防和治疗策略:系统综述

背景:对于患有血管性血友病(VWD)和大量月经出血(HMB)的女性，最佳围手术期处理方法仍未确定。目的和方法通过1994年至2023年的数据库检索，评估VWD合并HMB患者子宫内膜消融(EA)和子宫切除术后出血的术前处理。结果纳入6项队列研究和1例病例报告，总体质量“低”，描述了691例手术。100%(30/30)的EA手术和4%(24/661)的子宫切除术都采用了预防出血的方法(去氨加压素、凝血因子浓缩物或氨甲环酸)。13%(3/24)的子宫切除术患者有出血并发症，而0%(0/30)的子宫切除术患者有出血并发症。结论子宫切除术患者在子宫切除术过程中经常出现出血并发症，所有子宫切除术患者在手术前都使用了止血药物，这表明目前的预防策略可能不足或过量。需要前瞻性研究来确定VWD女性妇科手术的最佳(术前)策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Blood Reviews 医学-血液学

CiteScore

13.80

自引率

1.40%

发文量

期刊介绍： Blood Reviews, a highly regarded international journal, serves as a vital information hub, offering comprehensive evaluations of clinical practices and research insights from esteemed experts. Specially commissioned, peer-reviewed articles authored by leading researchers and practitioners ensure extensive global coverage across all sub-specialties of hematology.