How to Manage Anticoagulation in Patients with Bleeding Disorders

Patients suffering from the most common hereditary bleeding disorder von Willebrand disease (VWD) also undergoing surgical procedures are recommended specific treatment methods to manage perioperative anticoagulation.

To assess the efficacy and any possible complication associated with perioperative VTE prophylaxis in VWD patients, Mario Von Depka, MD, PhD, and colleagues conducted a retrospective study involving 116 surgeries.

A detailed analysis of the perioperative non-anticoagulation v. perioperative anticoagulation groups who all received coagulation factor concentrate (CFC) will be explored at the 57^th American Society of Hematology Annual Meeting (ASH 2015) in Orlando, Florida.

Anticoagulation was performed using different low molecular weight heparins (LMWH) according to standard protocols or body-weight adapted doses in patients with either elevated BMI or additional thrombosis risk factors.

After analyzing blood samples, study results showed the majority of patients suffered from VWD type I (104), nine from type 2A, two with type 2M, and one with type 3. Doses of LMWH (Enoxaparin, Nadroparin, and Certaparin) were administered between 30 and 100mg/injection — one patient had a significant haematoma and another experienced a thrombotic event.

The findings indicated that using standard dose LMWH in patients who did not exhibit overt increased thrombosis risk (and BMI adapted LMWH in high risk patients) was safe and effective in VWD patients who received perioperative coagulation factor concentrate.

“However, prospective randomized comparative studies are required to determine the optimal indication as well as type of anticoagulation according to the CFC treatment regimen in this setting,” concluded the authors.