Bleeding risk of surgery and its prevention in patients with inherited platelet disorders. The Surgery in Platelet disorders And Therapeutic Approach (SPATA) study

• Autores: Orsini, Sara; Noris, Patrizia; Bury, Loredana; Heller, Paula Graciela; Santoro, Cristina; Kadir RA; Butta, Nora C.; Falcinelli, Emanuela; Cid, Ana Rosa; Fabris, Fabrizio; Fouassier, Marc; Miyazaki, Koji; Lozano, Maria Luisa; Zuñiga, Pamela; Flaujac, Claire; Podda, Gian Marco; Bermejo, Nuria; Favier, Remi; Henskens, Yvonne; De Maistre, Emmanuel; De Candia, Erica; Mumford, Andrew; Ozdemir, Gul Nihal; Eker, Ibrahim; Nurden, Paquita; Bayart, Sophie; Lambert, Michele P; Bussel, James; Zieger, Barbara; Tosseto, Alberto; Melazzini, Federica; Glembotsky, Ana Claudia; Pecci, Alessandro; Cattaneo, Marco; Schlegel, Nicole; Gresele, Paolo
• Año de publicación: 2017
• Idioma: inglés
• Tipo de recurso: artículo
• Materia: PLATELETS; BLEEDING; INHERITED THROMBOCYTOPENIA; SURGERY
• Institución: Consejo Nacional de Investigaciones Científicas y Técnicas

Excessive bleeding at surgery is a feared complication in patients with inherited platelet disorders (IPD), however very few studies have evaluated the frequency of surgical bleeding in these hemorrhagic disorders. We performed a multicentric, retrospective worldwide study to assess the bleeding complications of surgery, the preventive and therapeutic approaches adopted and their efficacy in patients with IPDs by rating the outcome of 829 surgical procedures carried out in 423 patients with well defined forms of IPD (238 inherited platelet function disorders -IPFD- and 185 inherited platelet number disorders-IPND-). Frequency of surgical bleeding was high in patients with IPD (19.7%), with a significantly higher bleeding incidence in IPFDs (24.8%) than in IPNDs (13.4%). The frequency of bleeding varied according to the type of IPD, with biallelic Bernard Soulier syndrome having the highest occurrence (44.4%), and was predicted by a preoperative WHO bleeding score >/-2. Some types of surgery were associated with a higher bleeding incidence, like cardiovascular and urologic surgery. The use of preoperative prohemostatic treatments was associated with a lower bleeding frequency in patients with IPFD but not in IPNDs. Desmopressin, alone or with antifibrinolytic agents, was the preventive treatment associated with lowest bleedings. Platelet transfusions were used more frequently in patients at higher bleeding risk. Surgical bleeding risk in IPD is substantial, especially in IPFDs, and bleeding history, type of disorder, type of surgery and female gender are associated with higher bleeding frequency. Prophylactic preoperative prohemostatic treatments appear to be required and associated with a lower bleeding incidence.
Fil: Orsini, Sara. Università di Perugia; Italia
Fil: Noris, Patrizia. University Of Pavia. Policlinico San Matteo; Italia
Fil: Bury, Loredana. Università di Perugia; Italia
Fil: Heller, Paula Graciela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Médicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina
Fil: Santoro, Cristina. Università degli studi di Roma ; Italia
Fil: Kadir RA. Royal Free Hospital; Reino Unido
Fil: Butta, Nora C.. Hospital Universitario la Paz; España
Fil: Falcinelli, Emanuela. Università di Perugia; Italia
Fil: Cid, Ana Rosa. Hospital Universitario y Politecnico ; España
Fil: Fabris, Fabrizio. Università di Padova; Italia
Fil: Fouassier, Marc. Centre Hospitalier Universitaire de Nantes; Francia
Fil: Miyazaki, Koji. Kitasato University. School Of Medicine; Japón
Fil: Lozano, Maria Luisa. Universidad Carlos III de Madrid. Instituto de Salud; España
Fil: Zuñiga, Pamela. Pontificia Universidad Católica de Chile; Chile
Fil: Flaujac, Claire. Cochin Hospital; Francia
Fil: Podda, Gian Marco. Università degli Studi di Milano; Italia
Fil: Bermejo, Nuria. Hospital ; España
Fil: Favier, Remi. French Reference Centre For Inherited Platelet Disorder; Francia
Fil: Henskens, Yvonne. Maastricht University. Medical Centre; Países Bajos
Fil: De Maistre, Emmanuel. Centre Hospitalier Universitaire Dijon; Francia
Fil: De Candia, Erica. Universitá Cattolica Sacro. Policlinico Agostino Gemelli; Italia
Fil: Mumford, Andrew. University Of Bristol. School Of Clinical Sciences; Reino Unido
Fil: Ozdemir, Gul Nihal. Cerrahpasa Medical Faculty. Pediatric Hematology Depart; Turquía
Fil: Eker, Ibrahim. Gülhane Military Medical Faculty. Pediatric Hematology; Turquía
Fil: Nurden, Paquita. Xavier Arnozan Hospital; Francia
Fil: Bayart, Sophie. Centre Régional de Traitement Des Hémophiles; Francia
Fil: Lambert, Michele P. University of Pennsylvania; Estados Unidos
Fil: Bussel, James. Weill Cornell Medicine; Estados Unidos
Fil: Zieger, Barbara. University Medical Center Freiburg; Alemania
Fil: Tosseto, Alberto. San Bortolo Hospital; Italia
Fil: Melazzini, Federica. Università degli studi di Pavia. Policlinico San Matteo; Italia
Fil: Glembotsky, Ana Claudia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Médicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina
Fil: Pecci, Alessandro. Università degli studi di Pavia. Policlinico San Matteo; Italia
Fil: Cattaneo, Marco. Università degli Studi di Milano; Italia
Fil: Schlegel, Nicole. Centre Hospitalier Universitaire ; Francia
Fil: Gresele, Paolo. Università di Perugia; Italia