Knee replacement surgery in a patient with acquired von Willebrand disease: a case study with recommendations for patient management.
| Autor: | Álvarez Román MT; Departments ofHematology.; Department of Medicine, Autonomous University of Madrid, Madrid, Spain., Rivas Pollmar MI; Departments ofHematology., De la Corte-Rodríguez H; Physical and Rehabilitation Medicine., Gómez-Cardero P; Orthopedic Surgery, La Paz University Hospital, IdiPaz., Rodríguez-Merchán EC; Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research, IdiPAZ (La Paz University Hospital-Autonomous University of Madrid)., Gutiérrez-Alvariño M; Departments ofHematology., García-Pérez E; Departments ofHematology., Martín-Salces M; Departments ofHematology., Zagrean D; Departments ofHematology., Butta-Coll NV; Departments ofHematology., Jiménez-Yuste V; Departments ofHematology.; Department of Medicine, Autonomous University of Madrid, Madrid, Spain. |
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| Jazyk: | angličtina |
| Zdroj: | Annals of medicine and surgery (2012) [Ann Med Surg (Lond)] 2024 Jan 08; Vol. 86 (3), pp. 1681-1686. Date of Electronic Publication: 2024 Jan 08 (Print Publication: 2024). |
| DOI: | 10.1097/MS9.0000000000001690 |
| Abstrakt: | Introduction and Importance: Acquired von Willebrand disease (AvWD) is a rare underdiagnosed bleeding disorder caused by alterations in the levels of the major blood-clotting protein von Willebrand factor (vWF). The clinical and laboratory parameters of AvWD are similar to congenital vWD, but it is found in individuals with no positive family history with no underlying genetic basis. The disease remains multifactorial and incompletely understood. Proposed mechanisms include the development of autoantibodies to vWF, absorption of high molecular weight vWF multimers that impair normal function, shear stress induced vWF cleavage and increased proteolysis.The aetiology of the disease is variable, the most common being hematoproliferation, lymophoproliferation, myeloproliferation and autoimmune and cardiovascular disorders. Consensus and protocols for AvWD patients that require major surgery are currently lacking. Patients with AvWD can experience thrombotic events during surgery as a result of therapeutic interactions with pro-thrombotic risk factors. Case Presentation: Here, the authors report a patient with AvWD requiring a knee prosthesis implantation due to chronic pain, limited range of motion and functional impairment. The patient had a high risk of bleeding during surgery and was at risk of thrombosis due to age and obesity. Clinical Discussion: Perioperative care required a collaborative approach and the management of bleeding. The patient was administered vWF concentrate Willfact lacking Factor VIII to prevent haemorrhage and to minimize the risk of thrombosis. Conclusion: The treatment was effective and well-tolerated. The authors use this information to provide recommendations for AvWD patients for whom major surgery is indicated. Competing Interests: M.T.Á.-R. has participated as a speaker in advisory boards and sponsored symposia with Novo Nordisk, Bayer, Takeda, Roche, Pfizer, Octapharma, Amgen, Novartis, CSL Behring and Sobi. H.d.l.C.-R. has received honoraria for attending symposia/congresses and/or for speaking and/or consulting, and/or funds for research from Pfizer, Roche, Sobi, Novo Nordisk, Takeda and Bayer. V.J.Y. has participated as a speaker in advisory boards and sponsored symposia with Novo Nordisk, Bayer, Takeda, Roche, Pfizer, Octapharma, Amgen, Novartis, CSL Behring and Sobi. The remaining authors declare no conflict of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.) |
| Databáze: | MEDLINE |
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