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. 2024 Sep 16;8(7):102572.
doi: 10.1016/j.rpth.2024.102572. eCollection 2024 Oct.

Periprocedural hemostatic prophylaxis and outcomes in bleeding disorder of unknown cause

Callie Berkowitz  1 , Alice Ma  1 , Vanessa Miller  2 , Supreet Goraya  1 , Kristi Kirkland  1 , Julie Grabell  3 , Nigel S Key  1 , Paula D James  3
Affiliations

Periprocedural hemostatic prophylaxis and outcomes in bleeding disorder of unknown cause

Callie Berkowitz et al. Res Pract Thromb Haemost. .

Abstract

Background: Bleeding disorder of unknown cause (BDUC) is a diagnostic category encompassing patients with a clear bleeding phenotype but without identifiable abnormality on hemostatic testing. The optimal management of hemostasis in BDUC patients prior to invasive procedures and childbirth is uncertain.

Objectives: Our objective was to characterize periprocedural hemostatic prophylaxis and bleeding outcomes in patients with BDUC.

Methods: We conducted a retrospective cohort study of adult patients with BDUC at 2 academic medical centers. Following diagnosis of BDUC, subsequent surgical procedures and childbirths were analyzed using a combination of registry data and manual chart review.

Results: We identified 127 patients with mean age of 39.9 years (SD = 16.6); the majority of patients were female (91.3%). Forty-eight major procedures, 70 minor procedures, and 19 childbirths were analyzed. Antifibrinolytic monotherapy was advised for 57% of major procedures, 59% of minor procedures, and 67% of childbirths. Perioperative platelet transfusion was recommended in 26% of major procedures and 9% of minor procedures in combination with other hemostatic agents. Major or clinically relevant nonmajor bleeding occurred in 4.1% (4/98) of procedures with prophylaxis and 10% (2/20) of procedures without prophylaxis. Postpartum hemorrhage occurred in 26% (5/19) of deliveries.

Conclusion: In this multiinstitution experience, we found overall low rates of hemostatic complications in procedures completed with hemostatic prophylaxis, although preventing hemorrhage in childbirth and gynecologic procedures remain unmet needs.

Keywords: bleeding disorder of unknown cause; blood coagulation disorders; hemorrhagic disorders; postoperative hemorrhage; postpartum hemorrhage; unclassified bleeding disorder.

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Figures

Figure
Figure
Bleeding disorder of unknown cause patient CONSORT (Consolidated Standards of Reporting Trials) diagram.
See this image and copyright information in PMC

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