Bleeding perioperative bleeding prevention and treatment in patients with congenital bleeding disorders: Difference between revisions

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==2013 ESA Guidelines for the Management of Severe Perioperative Bleeding (DO NOT EDIT)<ref name="Kozek-Langenecker-2013">{{Cite journal  | last1 = Kozek-Langenecker | first1 = SA. | last2 = Afshari | first2 = A. | last3 = Albaladejo | first3 = P. | last4 = Santullano | first4 = CA. | last5 = De Robertis | first5 = E. | last6 = Filipescu | first6 = DC. | last7 = Fries | first7 = D. | last8 = Görlinger | first8 = K. | last9 = Haas | first9 = T. | title = Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. | journal = Eur J Anaesthesiol | volume = 30 | issue = 6 | pages = 270-382 | month = Jun | year = 2013 | doi = 10.1097/EJA.0b013e32835f4d5b | PMID = 23656742 }}</ref>==
==2013 ESA Guidelines for the Management of Severe Perioperative Bleeding (DO NOT EDIT)<ref name="Kozek-Langenecker-2013">{{Cite journal  | last1 = Kozek-Langenecker | first1 = SA. | last2 = Afshari | first2 = A. | last3 = Albaladejo | first3 = P. | last4 = Santullano | first4 = CA. | last5 = De Robertis | first5 = E. | last6 = Filipescu | first6 = DC. | last7 = Fries | first7 = D. | last8 = Görlinger | first8 = K. | last9 = Haas | first9 = T. | title = Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. | journal = Eur J Anaesthesiol | volume = 30 | issue = 6 | pages = 270-382 | month = Jun | year = 2013 | doi = 10.1097/EJA.0b013e32835f4d5b | PMID = 23656742 }}</ref>==


===Patients with Congenital Bleeding Disorders===


====von Willebrand Disease====


{|class="wikitable" style="width: 80%;"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 1]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' We recommend the use of [[bleeding]] assessment tools for predicting the perioperative risk of [[bleeding]]. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' We recommend that patients with [[VWD]] be managed perioperatively in collaboration with a [[hematologist]]. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' We recommend desmopressin as a first-line treatment for minor [[bleeding]]/[[surgery]] in patients with [[VWD]], after a trial testing. The regimen is specified by published guidelines. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' We recommend replacement of [[VWF]] with plasma-derived products for major [[bleeding]]/[[surgery]]. Treatment regimens are specified by published guidelines. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}


{|class="wikitable" style="width: 80%;"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 2]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' We suggest that if [[VWD]] is suspected preoperatively, the patient be referred to a [[hematologist]] for assessment and planning of the intervention. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' We suggest that [[fibrinolysis|antifibrinolytic drugs]] be used as hemostatic adjuncts. Treatment regimens are specified by published guidelines. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' We suggest that [[platelet]] [[transfusion]] may be used only in case of failure of other treatments. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
====Platelet Defects====
{|class="wikitable" style="width: 80%;"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 1]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' We recommend the use of a [[bleeding]] assessment tool for predicting the perioperative risk of [[bleeding]]. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' We recommend that patients with severe inherited [[platelet]] disorders should be managed perioperatively in collaboration with a [[hematologist]]. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' We recommend that [[Factor VII|rFVIIa]] treatment should be considered in patients with [[Glanzmann thrombasthenia]] undergoing [[surgery]]. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' We recommend against routine [[platelet]] [[transfusion]] in patients with inherited [[platelet]] disorders. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
{|class="wikitable" style="width: 80%;"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 2]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' We suggest referring the patient to a [[hematologist]] for assessment and planning of the intervention if inherited [[platelet]] defects are suspected preoperatively. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' We suggest preoperative hemostatic correction in patients with inherited [[platelet]] disorders. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' We suggest [[desmopressin]] be used to prevent/control perioperative [[bleeding]] in patients with inherited [[platelet]] defects. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' We suggest [[fibrinolysis|antifibrinolytic drugs]] be used as hemostatic adjuncts in procedures involving patients with inherited [[platelet]] defects. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
====Hemophilia A and B====
{|class="wikitable" style="width: 80%;"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 1]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' We recommend that [[hemophilia]] patients should be referred preoperatively to a [[hematologist]] for assessment/intervention. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' We recommend that [[surgery]] in [[hemophilia]] patients should be performed in specialised centres with expertise in [[coagulation]] disorders. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' We recommend adequate perioperative replacement therapy to ensure safe surgery in [[hemophilia]] patients. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' We recommend either recombinant products or plasma-derived concentrates for perioperative replacement therapy in [[hemophilia]] patients. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
{|class="wikitable" style="width: 80%;"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 2]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' We suggest that perioperative replacement therapy (target factor level and duration) in [[hemophilia]] patients follows published guidelines. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' We suggest that [[coagulation factor]]s be given perioperatively by continuous infusion. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' We suggest either [[Factor VII|rFVIIa]] or activated [[Prothrombin complex concentrate|PCCs]] for [[hemophilia]] patients with inhibitors. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' We suggest [[fibrinolysis|antifibrinolytic drugs]] as perioperative adjunct therapy in [[hemophilia]] patients. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' We suggest individualized perioperative thromboprophylaxis in [[hemophilia]] patients. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
====Rare Bleeding Disorders====
{|class="wikitable" style="width: 80%;"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 1]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' We recommend that patients with rare [[bleeding]] disorders should be referred preoperatively to a [[hematologist]] for assessment/intervention. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' We recommend that [[surgery]] in patients with rare bleeding disorders should be carried out in consultation with a [[hematologist]] with experience in factor deficiencies. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
{|class="wikitable" style="width: 80%;"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 2]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' We suggest that [[Factor VII|rFVIIa]] be used in perioperative [[bleeding]] due to inherited [[Factor VII|FVII]] deficiency. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' If [[Factor VII|rFVIIa]] is given to control perioperative [[bleeding]] in inherited [[Factor VII|FVII]] deficiency, we suggest lower doses than in [[hemophilia]] patients. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}


==Sources==
==Sources==

Revision as of 18:50, 21 April 2014

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Main article: Bleeding

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

2013 ESA Guidelines for the Management of Severe Perioperative Bleeding (DO NOT EDIT)[1]

Patients with Congenital Bleeding Disorders

von Willebrand Disease

Class 1
"1. We recommend the use of bleeding assessment tools for predicting the perioperative risk of bleeding. (Level of Evidence: C)"
"2. We recommend that patients with VWD be managed perioperatively in collaboration with a hematologist. (Level of Evidence: C)"
"3. We recommend desmopressin as a first-line treatment for minor bleeding/surgery in patients with VWD, after a trial testing. The regimen is specified by published guidelines. (Level of Evidence: C)"
"4. We recommend replacement of VWF with plasma-derived products for major bleeding/surgery. Treatment regimens are specified by published guidelines. (Level of Evidence: C)"
Class 2
"1. We suggest that if VWD is suspected preoperatively, the patient be referred to a hematologist for assessment and planning of the intervention. (Level of Evidence: C)"
"2. We suggest that antifibrinolytic drugs be used as hemostatic adjuncts. Treatment regimens are specified by published guidelines. (Level of Evidence: C)"
"3. We suggest that platelet transfusion may be used only in case of failure of other treatments. (Level of Evidence: C)"

Platelet Defects

Class 1
"1. We recommend the use of a bleeding assessment tool for predicting the perioperative risk of bleeding. (Level of Evidence: C)"
"2. We recommend that patients with severe inherited platelet disorders should be managed perioperatively in collaboration with a hematologist. (Level of Evidence: C)"
"3. We recommend that rFVIIa treatment should be considered in patients with Glanzmann thrombasthenia undergoing surgery. (Level of Evidence: C)"
"4. We recommend against routine platelet transfusion in patients with inherited platelet disorders. (Level of Evidence: C)"
Class 2
"1. We suggest referring the patient to a hematologist for assessment and planning of the intervention if inherited platelet defects are suspected preoperatively. (Level of Evidence: C)"
"2. We suggest preoperative hemostatic correction in patients with inherited platelet disorders. (Level of Evidence: C)"
"3. We suggest desmopressin be used to prevent/control perioperative bleeding in patients with inherited platelet defects. (Level of Evidence: C)"
"4. We suggest antifibrinolytic drugs be used as hemostatic adjuncts in procedures involving patients with inherited platelet defects. (Level of Evidence: C)"

Hemophilia A and B

Class 1
"1. We recommend that hemophilia patients should be referred preoperatively to a hematologist for assessment/intervention. (Level of Evidence: C)"
"2. We recommend that surgery in hemophilia patients should be performed in specialised centres with expertise in coagulation disorders. (Level of Evidence: C)"
"3. We recommend adequate perioperative replacement therapy to ensure safe surgery in hemophilia patients. (Level of Evidence: C)"
"4. We recommend either recombinant products or plasma-derived concentrates for perioperative replacement therapy in hemophilia patients. (Level of Evidence: C)"
Class 2
"1. We suggest that perioperative replacement therapy (target factor level and duration) in hemophilia patients follows published guidelines. (Level of Evidence: C)"
"2. We suggest that coagulation factors be given perioperatively by continuous infusion. (Level of Evidence: C)"
"3. We suggest either rFVIIa or activated PCCs for hemophilia patients with inhibitors. (Level of Evidence: C)"
"4. We suggest antifibrinolytic drugs as perioperative adjunct therapy in hemophilia patients. (Level of Evidence: C)"
"5. We suggest individualized perioperative thromboprophylaxis in hemophilia patients. (Level of Evidence: C)"

Rare Bleeding Disorders

Class 1
"1. We recommend that patients with rare bleeding disorders should be referred preoperatively to a hematologist for assessment/intervention. (Level of Evidence: C)"
"2. We recommend that surgery in patients with rare bleeding disorders should be carried out in consultation with a hematologist with experience in factor deficiencies. (Level of Evidence: C)"
Class 2
"1. We suggest that rFVIIa be used in perioperative bleeding due to inherited FVII deficiency. (Level of Evidence: C)"
"2. If rFVIIa is given to control perioperative bleeding in inherited FVII deficiency, we suggest lower doses than in hemophilia patients. (Level of Evidence: C)"

Sources

  • 2013 ESA Guidelines for the Management of Severe Perioperative Bleeding[1]

References

  1. ↑ 1.0 1.1 Kozek-Langenecker, SA.; Afshari, A.; Albaladejo, P.; Santullano, CA.; De Robertis, E.; Filipescu, DC.; Fries, D.; Görlinger, K.; Haas, T. (2013). "Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology". Eur J Anaesthesiol. 30 (6): 270–382. doi:10.1097/EJA.0b013e32835f4d5b. PMID 23656742. Unknown parameter |month= ignored (help)
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