Study finds post-surgery bleeding risk is higher for VWD kids
Retrospective analysis shows sixfold greater risk following tonsil, adenoid removal
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Children with von Willebrand disease (VWD) who undergo surgery to remove the adenoids and tonsils have a nearly sixfold higher risk of experiencing severe bleeding after surgery than those without bleeding disorders, a study in Poland found.
“These findings highlight the clinical relevance of VWD as an independent risk factor for postoperative hemorrhage and underscore the need for careful [surgical] planning and preparedness for bleeding management,” the researchers wrote.
The study, “Von Willebrand disease as a predictor of postoperative hemorrhagic complications in pediatric adenotonsillar surgery: a retrospective cohort study,” was published in European Archives of Oto-Rhino-Laryngology.
VWD is a bleeding disorder caused by a deficiency of von Willebrand factor (VWF), a protein involved in blood clotting, usually due to mutations in the VWF gene. As a result, the body cannot properly form blood clots, leading to symptoms such as abnormally heavy and prolonged bleeding.
The disease often remains undiagnosed in childhood, and in many cases, it is identified incidentally during surgical procedures. This includes surgery to remove the tonsils and adenoids — specialized structures at the back of the throat and behind the nose that provide the first line of defense against ingested or inhaled disease-causing organisms — that’s often performed in children. However, data directly evaluating the risk of bleeding after surgery in children with VWD is limited.
Analysis tracks children with, without VWD
The researchers retrospectively analyzed data from 134 children who underwent surgery to remove the adenoids and tonsils or only the adenoids. Forty-two had a confirmed diagnosis of VWD, and 92 who hadn’t been diagnosed with a bleeding disorder served as a control group. Some analyses were also performed based on data from 6,284 patients without VWD who underwent surgery during the study period.
Children with VWD had a median age of 5.8, were mainly boys (60.5%), and nearly all (92.9%) had VWD type 1, the most common and generally the mildest type of VWD.
Half underwent surgery to remove the adenoids and tonsils, while the other half had only the adenoids removed. Most (92.9%) received desmopressin before surgery to prevent bleeds, while three children required VWF replacement therapy.
All children started treatment with tranexamic acid, an antifibrinolytic agent that promotes blood clotting, the evening before surgery. They continued taking it for up to seven days after surgery, which was about the time they remained hospitalized.
Almost 12% of the children with VWD experienced bleeding after surgery, including severe bleeding in 4.8% of the cases. In the larger group of 6,284 patients without VWD who underwent surgery during the study period, the incidence of severe bleeding after surgery was 0.83%, meaning the risk of severe bleeding was nearly sixfold higher in children with VWD.
All children with VWD experienced bleeding within the first 24 hours of having surgery; this was not seen in any of the children in the control group. Bleeds occurring more than 24 hours after surgery were not reported in either group.
“This study demonstrates that vWD is associated with a significantly increased risk of severe postoperative bleeding in children undergoing [surgery to remove the adenoids and tonsils],” the researchers wrote. “Future prospective, multicenter studies with standardized definitions of bleeding and extended follow-up are warranted to further refine risk stratification strategies and optimize perioperative care for children with von Willebrand disease undergoing [this type of] surgery.”
