Premium
Unclassified bleeding disorders: outcome of haemostatic challenges following tranexamic acid and/or desmopressin
Author(s) -
Obaji S.,
Alikhan R.,
Rayment R.,
Carter P.,
Macartney N.,
Collins P.
Publication year - 2016
Publication title -
haemophilia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.213
H-Index - 92
eISSN - 1365-2516
pISSN - 1351-8216
DOI - 10.1111/hae.12811
Subject(s) - tranexamic acid , medicine , desmopressin , von willebrand disease , surgery , dental extraction , hemostatics , bleeding time , hemostasis , von willebrand factor , blood loss , platelet , platelet aggregation
In a minority of patients with a significant bleeding history no cause is found despite extensive testing and we diagnose such cases as unclassified bleeding disorders ( UBD ). UBD s may have diverse underlying causes and currently no standard management strategy exists in the event of a haemorrhage or to cover surgery. Aim To document the clinical characteristics and response to treatment of UBD s. Methods We performed a retrospective chart review of all patients with UBD s who had an invasive procedure at our centre between 1998 and 2014. Results The commonest symptoms were menorrhagia (89%) and bleeding at the time of surgery (88%) or dental extraction (85%). A total of 33 patients underwent 78 minor and major haemostatic challenges. Haemostatic cover was provided in 28 procedures with tranexamic acid alone, two with desmopressin and 45 with both agents in combination. A successful haemostatic outcome was observed in 70/78 (90%) cases. No patient required additional surgical intervention to achieve haemostasis, but one patient required a platelet transfusion to control postoperative bleeding. Conclusions This is the first study to report on the investigation and treatment of UBD . Future studies are needed to further our understanding of the bleeding phenotype and identify any underlying causes.