scholarly journals Gynecologic and obstetric management of women with von Willebrand disease: summary of 3 systematic reviews of the literature

2021 ◽  
Author(s):  
Romina Brignardello-Petersen ◽  
Abdallah El Alayli ◽  
Nedaa Husainat ◽  
Mohamad A. Kalot ◽  
Shaneela Shahid ◽  
...  
Keyword(s):  
Observational Studies ◽  
Case Series ◽  
Research Priorities ◽  
Neuraxial Anesthesia ◽  
Von Willebrand Disease ◽  
First Line ◽  
Study Selection ◽  
Obstetric Management ◽  
Meta Analyses ◽  
Von Willebrand

Von Willebrand disease, (VWD) disproportionately affects women due to potential issues with 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/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 undergoing labor and receiving neuraxial anesthesia and 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 approach. We included 1 randomized trial, 3 comparative observational studies and 10 case series. Moderate certainty evidence showed that desmopressin results in a smaller reduction of menstrual blood loss (difference in mean change from baseline, 41.6 [95% CI, 16.6 to 63.6] points in pictorial blood assessment chart score as compared to 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 TXA administration postpartum. 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 addressing research priorities will be key when updating such guidelines.

Management Strategies of Stroke and Acute Coronary Syndrome In Von Willebrand Disease and Hemophilia: Experience From a Case Series and a Swiss Survey of Frequencies.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1406-1406 ◽  
Author(s):  
Sara C. Meyer ◽  
Elina Armstrong ◽  
Christine Perdrizat ◽  
Hans-Rudolf Schmid ◽  
Riitta Lassila ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Ct Scan ◽  
Treatment Strategies ◽  
Case Series ◽  
Von Willebrand Disease ◽  
Bleeding Disorders ◽  
Coronary Syndrome ◽  
Federal Statistical ◽  
Swiss Population ◽  
Von Willebrand

Abstract Abstract 1406 Introduction: Thrombolysis and combined antiplatelet therapy is considered contraindicated in patients (pts) with bleeding disorders such as von Willebrand disease (VWD) and hemophilia (HP) presenting with stroke or acute coronary syndrome (ACS). Conservative treatment e.g. of stroke is often unsatisfactory in pts within the time window for thrombolysis. As stroke and ACS are common disorders, they may coincide with prevalent bleeding disorders such as VWD and HP and increase in frequency due to growing life expectancy in VWD and HP. An emergency protocol for safe management is desirable. Methods: We report on the management of 5 Caucasians with known VWD or HP suffering from stroke or ACS. In addition we screened the Swiss population of VWD and HP patients over 10y for the occurrence of stroke or ACS based on the data of the Swiss Federal Statistical Office. Case Series. Pt 1 is a 54-y-old Swiss female suffering from mild VWD 1 with a relevant bleeding history and characteristic VWF multimers (Tab 1). She presented with acute stroke with right hemiparesis (NIHSS 9) 2h after onset. CT scan excluded intracranial bleeding. Substitution of VWF/FVIII concentrate aiming at 80% of VWF activity resulted in 55% VWF ristocetin cofactor activity (RCo) and 76% VWF antigen (Ag). Concomitant thrombolysis with full-dose rtPA was performed. After 24h NIHSS improved to 6, RCo was 45%, Ag 63% and no signs of bleeding occurred. Secondary prophylaxis with aspirin was started. She fully recovered after 3 months. Pt 2, a 68-y-old Finnish female with VWD 2A presented with a minor stroke with mild left hemiparesis and a fall (NIHSS 2) 2h after onset. CT scan was normal and she was treated with dipyridamole. Symptoms regressed to NIHSS 0 after 6h. Pt 3 to 5 had ACS. Pt 3, a 73-y-old Swiss male with hemophilia B was successfully treated for unstable angina by percutaneous coronary intervention (PCI) with stenting at a subtotal stenosis of the RCA after substitution of FIX to 65%. Postinterventionally he was on clopidogrel for 2y and then switched to aspirin. Concomitant weekly substitution of FIX led to FIX peaks of ≂f55% and nadir of ≂f15%, was then reduced in frequency and stopped after 15 months. No bleeding complications occurred. Pt 4, a 67-y-old Finnish female with symptomatic VWD 3 presented with a NSTEMI and was successfully treated without PCI or platelet inhibition. Pt 5, a 70-y-old Finnish male with symptomatic VWD 2A suffered from ACS and had angiography with substitution of VWF/FVIII concentrate to 40–134% RCo and 134–252% Ag. Aortocoronary bypass surgery was planned due to 3-vessel disease. No antiplatelet therapy was started. Survey. The analysis of the Swiss Federal Statistical Office revealed 39 cases of VWD or HP with stroke or ACS over 10y (1998-2008) in the Swiss population of 7.70 millions (2008). A lower mean age at death in pts with VWD and HP (63 y) as compared to the normal population (77y), underreporting in the early years and a potential protective effect may contribute to reduced numbers. 19 pts with VWD showed 13 events of stroke and 6 of ACS while 20 hemophiliacs had 8 events of stroke and 12 of ACS. Conclusion: Our survey confirms the occurrence of stroke and ACS in pts with VWD and HP. Observed treatment strategies are very heterogeneous. Intravascular mechanical intervention such as PCI appears advantageous in pts with VWD and HP. If intravascular therapy is not timely available or not possible, we suggest substitution to ≂f80% VWF immediately followed by full-dose thrombolysis as described in pt 1. Repetitive substitution of VWF on a 12–24h basis or infusion over 48h may be adequate in severe deficiencies (Blood 2009;114:5256). A FIX level of 25% may suffice for safe PCI in hemophilia B given the clinical experience with oral anticoagulation. Generally, treatment strategies for stroke and ACS in pts with VWD and HP should be individually tailored and balanced between thrombotic and bleeding risk. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Complications of Hysterectomy in Women with Von Willebrand Disease.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3399-3399
Author(s):  
Andra H James ◽  
Evan R Myers ◽  
Chad Cook ◽  
Ricardo Pietrobon
Keyword(s):  
Case Reports ◽  
Postoperative Bleeding ◽  
Case Series ◽  
The United States ◽  
Von Willebrand Disease ◽  
Heavy Menstrual Bleeding ◽  
Menstrual Bleeding ◽  
Bleeding Complications ◽  
Risk Of Bleeding ◽  
Von Willebrand

Abstract Background: Case reports and small case series suggest that women with von Willebrand disease (VWD) are at a very high risk of bleeding complications with hysterectomy. Because the procedure may be beneficial to women who suffer from heavy menstrual bleeding, an understanding of the true risks involved is essential for appropriate decision making. Objectives: To estimate the incidence of bleeding and other complications in women with VWD who undergo hysterectomy. Methods: The United States Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality for the years 1988–2004 was queried for all hysterectomies for nonmalignant conditions. Data were analyzed based on the NIS sampling design. Bivariate analyses were used to examine the differences between women with and without VWD. Multivariate analysis was used to adjust for potential confounders among women who underwent hysterectomy for heavy menstrual bleeding. Results: 545 of the 1,358,133 hysterectomies were to women with VWD. Women with VWD were significantly more likely to experience intraoperative and postoperative bleeding (2.75% versus 0.89%, p < 0.001) and require transfusion (7.34% versus 2.13%, p < 0.001) than women without VWD. One woman with VWD died (odds ratio = 28.49). Conclusions: While the risk of bleeding complications from hysterectomy in women with VWD is smaller than previously reported, women with VWD did experience significantly more bleeding complications than women without VWD. Nonetheless, for women who have completed childbearing, the risks of hysterectomy may be acceptable.

scholarly journals Metatarsal Head Resections in Diabetic Foot Patients: A Systematic Review

2020 ◽  
Vol 9 (6) ◽  
pp. 1845 ◽  
Author(s):  
Irene Sanz-Corbalán ◽  
Aroa Tardáguila-García ◽  
Josep M. García-Alamino ◽  
Yolanda García-Álvarez ◽  
Francisco Javier Álvaro-Afonso ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Diabetic Foot ◽  
Observational Studies ◽  
Meta Analysis ◽  
Case Series ◽  
Metatarsal Head ◽  
Inclusion Criteria ◽  
Heterogeneity Test ◽  
Meta Analyses

A systematic review and proportional meta-analysis were carried out to investigate the complications that occur after surgical metatarsal head resection in diabetic foot patients. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist recommendations were applied, and the selected studies were evaluated using a Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist. PubMed (Medline) and Embase (Elsevier) were searched in December 2019 to find clinical trials, cohort studies, or case series assessing the efficacy of the metatarsal head resection technique in diabetic foot patients. The systematic review covered 21 studies that satisfied the inclusion criteria and included 483 subjects. The outcomes evaluated were the time to heal, recurrence, reulceration, amputation, and other complications. The proportion of recurrence was 7.2% [confidence interval (CI) 4.0–10.4, p < 0.001], that of reulceration was 20.7% (CI 11.6–29.8, p < 0.001), and that of amputation was 7.6% (CI 3.4–11.8, p < 0.001). A heterogeneity test indicated I2 = 72.6% (p < 0.001) for recurrences, I2 = 94% (p < 0.001) for reulcerations, and I2 = 79% (p < 0.001) for amputations. We conclude that metatarsal head resections in diabetic foot patients are correlated with significant complications, especially reulceration.

Type 1 von Willebrand disease due to reduced von Willebrand factor synthesis and/or survival: observations from a case series

2010 ◽  
Vol 155 (4) ◽  
pp. 200-208 ◽  
Author(s):  
Alessandra Casonato ◽  
Lisa Gallinaro ◽  
Maria Grazia Cattini ◽  
Francesca Sartorello ◽  
Elena Pontara ◽  
...  
Keyword(s):  
Von Willebrand Factor ◽  
Case Series ◽  
Von Willebrand Disease ◽  
Von Willebrand ◽  
Willebrand Factor

Efficacy and Safety of First- and Second-Line Drugs to Prevent Glucocorticoid-Induced Fractures

2019 ◽  
Vol 105 (3) ◽  
pp. 600-613 ◽  
Author(s):  
Liangliang Ding ◽  
Jinxi Hu ◽  
Dehua Wang ◽  
Qi Liu ◽  
Yuxia Mo ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Data Extraction ◽  
Outcome Data ◽  
Sensitivity Analyses ◽  
Second Line ◽  
Efficacy And Safety ◽  
First Line ◽  
Study Selection ◽  
Induced Fractures ◽  
Meta Analyses

Abstract Context The evidence about benefits and harms of drugs for glucocorticoid (GC)-induced osteoporosis (GIOP) is limited, and the comparative efficacy and safety of first-line and second-line agents to prevent GC-induced (GI) fractures remains unclear. Objective To assess the comparative clinical efficacy, safety, and tolerability of first-line and second-line agents in preventing GI fractures. Data Sources We searched 3 different databases through March 5, 2019. Study Selection We included randomized controlled trials enrolling patients receiving long-term GCs and compared a first-line and second-line agent with one another and with placebo. Data Extraction Two reviewers independently extracted study and participant characteristics and outcome data. Data Synthesis We performed multivariate random-effects network meta-analyses including base, 3 subgroups, and 12 sensitivity analyses. We included 22 papers from 19 unique trials involving 4328 patients receiving GCs. Teriparatide (risk ratio [RR] 0.11, 95% confidence interval [CI] 0.03–0.47), denosumab (RR 0.21, 95% CI 0.09–0.49), and risedronate (RR 0.33, 95% CI 0.19–0.58) reduced the risk of GI vertebral fractures, and the former 2 were the most efficacious according to violin plots including the surface under the cumulative ranking curve values calculated by base and sensitivity analyses. Oral alendronate (RR 0.33, 95% CI 0.12–0.93) reduced this risk in patients receiving GCs with at least 7.5 mg/day, while intravenous ibandronate (RR 0.25, 95% CI 0.06–0.99) was efficacious for the primary prevention of GIOP. Six drugs were similar in terms of the 5 other outcomes. Conclusions In terms of clinical efficacy and safety, second-line teriparatide and denosumab pose a challenge to first-line oral bisphosphonates for prevention of GI fractures.

scholarly journals S-Amlodipine: An Isomer with Difference—Time to Shift from Racemic Amlodipine

2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Jamshed Dalal ◽  
J. C. Mohan ◽  
S. S. Iyengar ◽  
Jagdish Hiremath ◽  
Immaneni Sathyamurthy ◽  
...  
Keyword(s):  
Observational Studies ◽  
Clinical Evidence ◽  
Controlled Trials ◽  
Channel Blockers ◽  
Efficacy And Safety ◽  
First Line ◽  
Randomized Controlled ◽  
Treatment Of Hypertension ◽  
Meta Analyses ◽  
Difference Time

Calcium channel blockers are among the first-line drugs for treatment of hypertension (HTN). S-amlodipine (S-AM), an S-enantiomer of amlodipine, is available in India and in other countries like China, Korea, Russia, Ukraine, and Nepal. Being clinically researched for nearly two decades, we performed in-depth review of S-AM. This review discusses clinical evidence from total 42 studies (26 randomized controlled trials, 14 observational studies, and 2 meta-analyses) corroborating over 7400 patients treated with S-AM. Efficacy and safety of S-AM in HTN in comparison to racemic amlodipine, used as monotherapy and in combination with other antihypertensives, efficacy in angina, and pleiotropic benefits with S-AM, are discussed in this review.

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