Perioperative bleeding and thrombotic risks in patients with Von Willebrand disease.
Perioperative bleeding and thrombotic risks in patients with Von Willebrand disease.
复制标题
冯·维勒布兰德病患者的围手术期出血和血栓形成风险。
DOI：
10.1007/s11239-017-1504-2
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发表时间：
2017
影响因子：
4
通讯作者：
Berger,JeffreyS
中科院分区：
文献类型：
--
作者：
Smilowitz,NathanielR;Gupta,Navdeep;Guo,Yu;Bangalore,Sripal;Berger,JeffreyS
血管性血友病（VWD）是一种遗传性出血性疾病，临床上常表现为侵入性手术后出血。我们在美国的一个大型国家数据库中调查了VWD诊断与重大非心脏手术后出血和血栓形成结局之间的关系。从医疗保健成本和利用项目的国家住院患者样本数据中确定了年龄≥45岁需要重大非心脏手术的患者。血管性血友病、围手术期主要不良心血管事件（MACE）、血栓形成事件和出血均由ICD 9诊断代码定义。从2004年到2013年，共有10，581，621例因重大非心脏手术而住院的患者符合研究入选标准，其中3765例（0.036%）被确定为VWD。在校正分析中，VWD患者发生术后出血的可能性显著高于无VWD患者（5.5 vs. 1.9%，p < 0.001;校正OR 3.49，95% CI 3.03-4.03），但围手术期MACE和血栓事件的几率相似。因此，与无VWD的患者相比，VWD的诊断与非心脏手术的出血风险增加相关，而围手术期血栓形成没有相应减少。遗传性出血性疾病患者的围手术期管理和血栓形成风险的减轻需要进一步研究。
Von Willebrand disease (VWD) is an inherited bleeding disorder that often manifests clinically with hemorrhage after invasive procedures. We investigated the association between a diagnosis of VWD and bleeding and thrombotic outcomes following major non-cardiac surgery in a large national database from the United States. Patients age ≥45 years requiring major non-cardiac surgery were identified from Healthcare Cost and Utilization Project’s National Inpatient Sample data. Von Willebrand disease, perioperative major adverse cardiovascular events (MACE), thrombotic events, and hemorrhage were defined by ICD9 diagnosis codes. From 2004 to 2013, a total of 10,581,621 hospitalizations for major non-cardiac surgery met study inclusion criteria and VWD was identified in 3765 (0.036%). In adjusted analyses, patients with VWD were significantly more likely to develop post-operative hemorrhage than patients without VWD (5.5 vs. 1.9%, p < 0.001; adjusted OR 3.49, 95% CI 3.03–4.03), but had similar odds of perioperative MACE and thrombotic events. Thus, a diagnosis of VWD was associated with increased risks of bleeding with non-cardiac surgery, without a corresponding reduction in perioperative thrombosis in comparison to patients without VWD. Perioperative management of patients with hereditary bleeding disorders and mitigation of thrombotic risks requires further study.