Bleeding risk of surgery and its prevention in patients with inherited platelet disorders: The Surgery in Platelet disorders And Therapeutic Approach (SPATA) study

Sara Orsini, Patrizia Noris, Loredana Bury, Paula G Heller, Cristina Santoro, Rezan A Kadir, Nora C Butta, Emanuela Falcinelli, Ana Rosa Cid, Fabrizio Fabris, Marc Fouassier, Koji Miyazaki, Maria Luisa Lozano, Pamela Zuñiga, Claire Flaujac, Gian Marco Podda, Nuria Bermejo, Remi Favier, Yvonne Henskens, Emmanuel De MaistreErica De Candia, Andrew D Mumford, Nihal G Ozdemir, Ibrahim Eker, Paquita Nurden, Sophie Bayart, Michele P Lambert, James Bussel, Barbara Zieger, Alberto Tosetto, Federica Melazzini, Ana C Glembotsky, Alessandro Pecci, Marco Cattaneo, Nicole Schlegel, Paolo Gresele

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Excessive bleeding at surgery is a feared complication in patients with inherited platelet disorders (IPD), however very few studies have evaluated the frequency of surgical bleeding in these hemorrhagic disorders. We performed a multicentric, retrospective worldwide study to assess the bleeding complications of surgery, the preventive and therapeutic approaches adopted and their efficacy in patients with IPDs by rating the outcome of 829 surgical procedures carried out in 423 patients with well defined forms of IPD (238 inherited platelet function disorders -IPFD- and 185 inherited platelet number disorders-IPND-). Frequency of surgical bleeding was high in patients with IPD (19.7%), with a significantly higher bleeding incidence in IPFDs (24.8%) than in IPNDs (13.4%). The frequency of bleeding varied according to the type of IPD, with biallelic Bernard Soulier syndrome having the highest occurrence (44.4%), and was predicted by a preoperative WHO bleeding score >/-2. Some types of surgery were associated with a higher bleeding incidence, like cardiovascular and urologic surgery. The use of preoperative prohemostatic treatments was associated with a lower bleeding frequency in patients with IPFD but not in IPNDs. Desmopressin, alone or with antifibrinolytic agents, was the preventive treatment associated with lowest bleedings. Platelet transfusions were used more frequently in patients at higher bleeding risk. Surgical bleeding risk in IPD is substantial, especially in IPFDs, and bleeding history, type of disorder, type of surgery and female gender are associated with higher bleeding frequency. Prophylactic preoperative prohemostatic treatments appear to be required and associated with a lower bleeding incidence.
Original languageEnglish
Pages (from-to)1192-1203
Number of pages12
JournalHaematologica
Volume102
Issue number7
Early online date6 Apr 2017
DOIs
Publication statusPublished - Jul 2017

Keywords

  • Journal Article

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