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@article{Brignardello-Petersen:2022:10.1182/bloodadvances.2021005666,
author = {Brignardello-Petersen, R and El, Alayli A and Husainat, N and Kalot, M and Shahid, S and Aljabirii, Y and Britt, A and Alturkmani, H and El-Khechen, H and Motaghi, S and Roller, J and Dimassi, A and Abughanimeh, O and Madoukh, B and Arapshian, A and Grow, JM and Kouides, P and Laffan, M and Leebeek, FWG and O'Brien, SH and Tosetto, A and James, PD and Connell, NT and Flood, V and Mustafa, RA},
doi = {10.1182/bloodadvances.2021005666},
journal = {Blood Advances},
pages = {121--128},
title = {Surgical management of patients with von Willebrand disease: summary of 2 systematic reviews of the literature},
url = {http://dx.doi.org/10.1182/bloodadvances.2021005666},
volume = {6},
year = {2022}
}

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TY  - JOUR
AB  - von Willebrand disease (VWD) is the most common inherited bleeding disorder. The management of patients with VWD who are undergoing surgeries is crucial to prevent bleeding complications. We systematically summarized the evidence on the management of patients with VWD who are undergoing major and minor surgeries to support the development of practice guidelines. We searched Medline and EMBASE from inception through October 2019 for randomized clinical trials (RCTs), comparative observational studies, and case series that compared maintaining factor VIII (FVIII) levels or von Willebrand factor (VWF) levels at >0.50 IU/mL for at least 3 days in patients undergoing major surgery, and those with options for perioperative management of patients undergoing minor surgery. Two authors screened and abstracted data and assessed the risk of bias. We conducted meta-analyses when possible. We evaluated the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We included 7 case series for major surgeries and 2 RCTs and 12 case series for minor surgeries. Very-low-certainty evidence showed that maintaining FVIII levels or VWF levels of >0.50 IU/mL for at least 3 consecutive days showed excellent hemostatic efficacy (as labeled by the researchers) after 74% to 100% of major surgeries. Low- to very-low-certainty evidence showed that prescribing tranexamic acid and increasing VWF levels to 0.50 IU/mL resulted in fewer bleeding complications after minor procedures compared with increasing VWF levels to 0.50 IU/mL alone. Given the low-quality evidence for guiding management decisions, a shared-decision model leading to individualized therapy plans will be important in patients with VWD who are undergoing surgical and invasive procedures.
AU  - Brignardello-Petersen,R
AU  - El,Alayli A
AU  - Husainat,N
AU  - Kalot,M
AU  - Shahid,S
AU  - Aljabirii,Y
AU  - Britt,A
AU  - Alturkmani,H
AU  - El-Khechen,H
AU  - Motaghi,S
AU  - Roller,J
AU  - Dimassi,A
AU  - Abughanimeh,O
AU  - Madoukh,B
AU  - Arapshian,A
AU  - Grow,JM
AU  - Kouides,P
AU  - Laffan,M
AU  - Leebeek,FWG
AU  - O'Brien,SH
AU  - Tosetto,A
AU  - James,PD
AU  - Connell,NT
AU  - Flood,V
AU  - Mustafa,RA
DO  - 10.1182/bloodadvances.2021005666
EP  - 128
PY  - 2022///
SN  - 2473-9529
SP  - 121
TI  - Surgical management of patients with von Willebrand disease: summary of 2 systematic reviews of the literature
T2  - Blood Advances
UR  - http://dx.doi.org/10.1182/bloodadvances.2021005666
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000753720500012&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://ashpublications.org/bloodadvances/article/6/1/121/477340/Surgical-management-of-patients-with-von
UR  - http://hdl.handle.net/10044/1/96383
VL  - 6
ER  -

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