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Brignardello-Petersen R, El Alayli A, Husainat N, Kalot MA, Shahid S, Aljabirii Y, Britt A, Alturkmani H, El-Khechen H, Motaghi S, Roller J, Abdul-Kadir R, Couper S, Kouides P, Lavin M, Ozelo MC, Weyand A, James PD, Connell NT, Flood VH, Mustafa RA. Gynecologic and obstetric management of women with von Willebrand disease: summary of 3 systematic reviews of the literature. Blood Adv 2022; 6:228-237. [PMID: 34673921 PMCID: PMC8753192 DOI: 10.1182/bloodadvances.2021005589] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
von Willebrand disease (VWD) disproportionately affects women because of the potential for heavy menstrual bleeding (HMB), delivery complications, and postpartum hemorrhage (PPH). To systematically synthesize the evidence regarding first-line management of HMB, treatment of women requiring or desiring neuraxial analgesia, and management of PPH. We searched Medline and EMBASE through October 2019 for randomized trials, comparative observational studies, and case series comparing the effects of desmopressin, hormonal therapy, and tranexamic acid (TxA) on HMB; comparing different von Willebrand factor (VWF) levels in women with VWD who were undergoing labor and receiving neuraxial anesthesia; and measuring the effects of TxA on PPH. We conducted duplicate study selection, data abstraction, and appraisal of risk of bias. Whenever possible, we conducted meta-analyses. We assessed the quality of the evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. We included 1 randomized trial, 3 comparative observational studies, and 10 case series. Moderate-certainty evidence showed that desmopressin resulted in a smaller reduction of menstrual blood loss (difference in mean change from baseline, 41.6 [95% confidence interval, 16.6-63.6] points in a pictorial blood assessment chart score) as compared with TxA. There was very-low-certainty evidence about how first-line treatments compare against each other, the effects of different VWF levels in women receiving neuraxial anesthesia, and the effects of postpartum administration of TxA. Most of the evidence relevant to the gynecologic and obstetric management of women with VWD addressed by most guidelines is very low quality. Future studies that address research priorities will be key when updating such guidelines.
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Affiliation(s)
| | - Abdallah El Alayli
- Outcomes and Implementation Research Unit, Department of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS
| | - Nedaa Husainat
- Department of Internal Medicine, St. Mary’s Hospital, St. Louis, MO
| | - Mohamad A. Kalot
- Department of Internal Medicine, State University of New York at Buffalo, Buffalo, NY
| | - Shaneela Shahid
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | - Alec Britt
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Hani Alturkmani
- Department of Cardiovascular Medicine University of Arkansas for Medical Sciences, Little Rock, AR
| | - Hussein El-Khechen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Shahrzad Motaghi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - John Roller
- Department of Hematology/Oncology, University of Kansas Medical Center, Kansas City, KS
| | - Rezan Abdul-Kadir
- The Royal Free National Health Service Foundation (NHS) Hospital and Institute for Women’s Health, University College London, London, United Kingdom
| | | | - Peter Kouides
- Mary M. Gooley Hemophilia Treatment Center, University of Rochester, Rochester, NY
| | - Michelle Lavin
- Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
- National Coagulation Centre, St. James’ Hospital, Dublin, Ireland
| | | | - Angela Weyand
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Paula D. James
- Department of Medicine, Queen’s University, Kingston, ON, Canada
| | - Nathan T. Connell
- Hematology Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Veronica H. Flood
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI; and
- Versiti Blood Research Institute, Milwaukee, WI
| | - Reem A. Mustafa
- Outcomes and Implementation Research Unit, Department of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS
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Ramspoth T, Roehl AB, Macko S, Heidenhain C, Junge K, Binnebösel M, Schmeding M, Neumann UP, Rossaint R, Hein M. Risk factors for coagulopathy after liver resection. J Clin Anesth 2014; 26:654-62. [PMID: 25468574 DOI: 10.1016/j.jclinane.2014.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 08/09/2014] [Accepted: 08/22/2014] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVE To identify risk factors for coagulopathy in patients undergoing liver resection. DESIGN A retrospective cohort study. SETTING Patients who underwent liver resection at a university hospital between April 2010 and May 2011 were evaluated within seven days after surgery. PATIENTS One hundred forty-seven patients were assessed for eligibility. Thirty needed to be excluded because of incomplete data (23) or a preexisting coagulopathy (7). MEASUREMENTS Coagulopathy was defined as 1 or more of the following events: international normalized ratio ≥1.4, platelet count <80,000/μL, and partial thromboplastin time >38 seconds. Related to the time course and coagulation profile thresholds, 3 different groups could be distinguished: no coagulopathy, temporary coagulopathy, and persistent coagulopathy. MAIN RESULTS Seventy-seven patients (65.8%) had no coagulopathy, whereas 33 (28.2%) developed temporary coagulopathy and 7 (6%) developed persistent coagulopathy until day 7. Preoperative international normalized ratio (P = .001), postoperative peak lactate levels (P = .012), and resected liver weight (P = .005) were identified as independent predictors. Preoperative liver transaminases and transfusion volumes of red blood cells and fresh frozen plasma were significantly higher in patients with persistent coagulopathy. CONCLUSIONS Epidural anesthesia is feasible in patients scheduled for liver resection. Caution should be observed for patients with extended resection (≥3 segments) and increased postoperative lactate. In patients with preexisting liver disease, epidural catheters should be avoided.
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Affiliation(s)
- Tina Ramspoth
- Department of Anesthesiology, University Hospital Aachen, RWTH, Aachen, Germany
| | - Anna B Roehl
- Department of Anesthesiology, University Hospital Aachen, RWTH, Aachen, Germany
| | - Stephan Macko
- Department of Anesthesiology, University Hospital Aachen, RWTH, Aachen, Germany
| | - Cristoph Heidenhain
- General, Visceral and Transplantation Surgery, University Hospital Aachen, RWTH, Aachen, Germany
| | - Karsten Junge
- General, Visceral and Transplantation Surgery, University Hospital Aachen, RWTH, Aachen, Germany
| | - Marcel Binnebösel
- General, Visceral and Transplantation Surgery, University Hospital Aachen, RWTH, Aachen, Germany
| | - Maximilian Schmeding
- General, Visceral and Transplantation Surgery, University Hospital Aachen, RWTH, Aachen, Germany
| | - Ulf P Neumann
- General, Visceral and Transplantation Surgery, University Hospital Aachen, RWTH, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, University Hospital Aachen, RWTH, Aachen, Germany
| | - Marc Hein
- Department of Anesthesiology, University Hospital Aachen, RWTH, Aachen, Germany.
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[Quality of postoperative pain therapy: evaluation of an established anesthesiology acute pain service]. Anaesthesist 2013; 62:453-9. [PMID: 23670580 DOI: 10.1007/s00101-013-2177-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 04/08/2013] [Accepted: 04/15/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite well-designed concepts of perioperative pain management, recent studies have revealed that a large number of patients still suffer from unacceptable pain after surgery. The purpose of this prospective evaluation was to critically analyze postoperative pain treatment provided by a routinely established, DIN certified acute pain service (APS) at the University Hospital Großhadern in Munich. MATERIALS AND METHODS A total of 1,000 consecutive patients received one of the following analgesic procedures: continuous epidural analgesia (EA, n = 401), continuous and patient-controlled epidural analgesia (PCEA, n = 305), intravenous patient-controlled analgesia with opioids (PCA, n = 169) or continuous peripheral nerve block (CPNB, n = 125). For EA and PCEA, ropivacaine 0.2 % and sufentanil 0.24 µg/ml were administered while peripheral regional analgesia was performed with infusion of ropivacaine 0.2 % only. Patients with PCEA were allowed a 3 mg bolus once per hour on demand. Standardized intravenous PCA was performed with piritramide 2.5 mg/ml, a bolus of 2.5 mg, a lock-out time of 15 min, a maximum of 25 mg/4 h and no background infusion. During the daily visits the APS assessed pain intensity at rest and during movement on a numerical rating scale from 0 (no pain) to 10 (maximum pain), acceptance of pain, satisfaction with the analgesic procedure, demand of additional non-opioid analgesics, the need for optimization including bolus applications and changes of the infusion rate or retraction of the epidural catheter. The duration of the procedures, side effects and complications were documented. The catheter insertion sites were inspected daily for redness and tenderness on palpation. RESULTS In general, epidural and peripheral regional analgesic techniques were superior in terms of postoperative analgesia to intravenous opioid PCA and were associated with fewer side effects, such as sedation, nausea, vomiting, obstipation and sensorimotor deficits. A subgroup analysis revealed that in major upper abdominal surgery, EA provided significantly better analgesia at rest and during movement than PCA. In lower abdominal surgery PCEA induced significantly better analgesia than both PCA and EA, especially during movement. Patient satisfaction was generally high and was best with PCEA (95 %) followed by CPNB (94 %), EA (91 %) and PCA (88 %). On the first postoperative day analgesic procedures had to be optimized (e.g. by bolus administration, retraction of catheters or changes to standardized PCA) in 23 % of EA patients, 10 % of PCEA patients, 6 % of PCA patients and 12 % of CPNB patients. Major complications, such as neuraxial hematoma, infections or respiratory depression were not observed. CONCLUSIONS As described in many prospective studies, this evaluation revealed that for postoperative pain control, regional anesthesia is superior to intravenous patient-controlled analgesia with strong opioids in terms of analgesia and side effects. In the setting of a well-organized acute pain service with frequent education and training of all members involved, postoperative pain management is safe and effective. However, regular re-evaluation of the defined and certified procedures is necessary.
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