OBJECTIVES: 1) Compare rates of post-tonsillectomy bleeding in pediatric patients with and without von Willebrand disease (vWD). 2) Identify factors that may increase the risk for post-tonsillectomy bleeding in children with and without vWD. STUDY DESIGN: Historical cohort study. SETTING: Tertiary care, university-based pediatric hospital. SUBJECTS AND METHODS: Medical records were examined for 99 patients with vWD and 99 patients without vWD younger than 18 years who underwent tonsillectomy with or without adenoidectomy from August 1997 to October 2005. Subjects were matched for age, year of surgery, type of surgery, and indication for surgery. RESULTS: Post-tonsillectomy hemorrhage occurred in eight of 99 (8%) vWD patients and in six of 99 (6%) non-vWD patients (P = 0.58, odds ratio 1.36, 95% CI 0.45-4.08). A two-sample test of proportions demonstrated lower and upper limits of -0.051 and 0.092. Four of eight children with vWD and two of six non-vWD patients required surgical intervention for control of bleeding. Ninety-three of 99 vWD patients received desmopressin acetate (DDAVP) preoperatively. In patients with vWD who responded to DDAVP challenge, there was no increased likelihood of post-tonsillectomy bleeding compared with non-vWD patients. No significant difference in the number of bleeding events was noted on the basis of demographics, preoperative laboratories, or use of aminocaproic acid. CONCLUSION: Children with vWD undergoing tonsillectomy have a postoperative bleeding rate similar to that of a matched group. However, the sample size was not sufficient to eliminate the possibility of a clinically important difference between the two groups. Copyright 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.
OBJECTIVES: 1) Compare rates of post-tonsillectomy bleeding in pediatric patients with and without von Willebrand disease (vWD). 2) Identify factors that may increase the risk for post-tonsillectomy bleeding in children with and without vWD. STUDY DESIGN: Historical cohort study. SETTING: Tertiary care, university-based pediatric hospital. SUBJECTS AND METHODS: Medical records were examined for 99 patients with vWD and 99 patients without vWD younger than 18 years who underwent tonsillectomy with or without adenoidectomy from August 1997 to October 2005. Subjects were matched for age, year of surgery, type of surgery, and indication for surgery. RESULTS: Post-tonsillectomy hemorrhage occurred in eight of 99 (8%) vWDpatients and in six of 99 (6%) non-vWDpatients (P = 0.58, odds ratio 1.36, 95% CI 0.45-4.08). A two-sample test of proportions demonstrated lower and upper limits of -0.051 and 0.092. Four of eight children with vWD and two of six non-vWDpatients required surgical intervention for control of bleeding. Ninety-three of 99 vWDpatients received desmopressin acetate (DDAVP) preoperatively. In patients with vWD who responded to DDAVP challenge, there was no increased likelihood of post-tonsillectomy bleeding compared with non-vWDpatients. No significant difference in the number of bleeding events was noted on the basis of demographics, preoperative laboratories, or use of aminocaproic acid. CONCLUSION:Children with vWD undergoing tonsillectomy have a postoperative bleeding rate similar to that of a matched group. However, the sample size was not sufficient to eliminate the possibility of a clinically important difference between the two groups. Copyright 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.
Authors: D J Mancuso; E A Tuley; L A Westfield; N K Worrall; B B Shelton-Inloes; J M Sorace; Y G Alevy; J E Sadler Journal: J Biol Chem Date: 1989-11-25 Impact factor: 5.157
Authors: Jack L Paradise; Charles D Bluestone; D Kathleen Colborn; Beverly S Bernard; Howard E Rockette; Marcia Kurs-Lasky Journal: Pediatrics Date: 2002-07 Impact factor: 7.124