Prophylactic and therapeutic strategies for intraoperative bleeding in women with von Willebrand disease and heavy menstrual bleeding: A systematic review

Blood Rev. 2023 Nov:62:101131. doi: 10.1016/j.blre.2023.101131. Epub 2023 Sep 7.

Abstract

Background: Optimal peri-operative management for women with Von Willebrand disease (VWD) and heavy menstrual bleeding (HMB) remains undetermined.

Aim and methods: To evaluate (pre)operative management in relation to (post)operative bleeding after endometrial ablation (EA) and hysterectomy in VWD women with HMB by performing a database search between 1994 and 2023.

Results: Eleven cohort studies and 1 case-report were included, of overall 'low' quality, describing 691 operative procedures. Prophylaxis (Desmopressin, clotting factor concentrates or tranexamic acid) to prevent bleeding was described in 100% (30/30) of EA procedures and in 4% (24/661) of hysterectomies. Bleeding complications despite prophylaxis were described in 13% (3/24) of hysterectomies vs 0% (0/30) in EA.

Conclusion: VWD women often seem to experience bleeding complications during hysterectomy and all women with VWD received preprocedural hemostatic agents during EA, indicating potential under- and overdosing of current prophylactic strategies. Prospective studies are needed to determine the optimal (pre)operative strategy for gynecological surgical procedures in women with VWD.

Keywords: Bleeding disorders; Endometrial ablation techniques; Heavy menstrual bleeding; International society on thrombosis and Haemostasis bleeding assessment tool; von Willebrand disease.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Female
  • Hemorrhage
  • Humans
  • Menorrhagia* / complications
  • Menorrhagia* / therapy
  • Prospective Studies
  • Tranexamic Acid* / therapeutic use
  • von Willebrand Diseases* / complications
  • von Willebrand Diseases* / therapy
  • von Willebrand Factor

Substances

  • Tranexamic Acid
  • von Willebrand Factor