Antifibrinolytic therapy for preventing VWD-related postpartum hemorrhage: indications and limitations

Kouides, Peter A.

doi:10.1182/bloodadvances.2017005082

Cited by 7 publications

(5 citation statements)

References 31 publications

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“…In women with confirmed PPH, the use of TxA reduced the risk of hysterectomy. [35][36][37]50,51 Thromboprophylactic treatment after cesarean section with low-molecularweight heparin should be administered to patients to attenuate the risk of venous thromboembolism. Women with VWD are also at a higher risk of heavy lochia loss during the puerperium, since the pregnancy-induced rise in VWF and FVIII decreases within a few days after delivery.…”

Section: Peripartal Managementmentioning

confidence: 99%

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Von Willebrand Disease—Specific Aspects in Women

Eladly

Miesbach

2022

Hamostaseologie

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Von Willebrand disease (VWD) is the most common inherited bleeding disorder, which results from a deficiency or dysfunction of von Willebrand factor (VWF). The major symptoms of patients affected by VWD include mucocutaneous and gastrointestinal bleeding, easy bruising, and prolonged provoked bleeding due to injury or surgery. Although women and men are equally likely to be affected by VWD, women continue to be disproportionately affected by the bleeding challenges. Women with VWD suffer from sex-specific symptoms, such as menorrhagia, and are at higher risk of reproductive problems and recurrent miscarriage. Furthermore, pregnant women with VWD are more likely at higher risk of suffering from primary and secondary peripartal hemorrhage and anemia and the need for transfusions. Despite being affected by gynecologic and obstetrical bleeding, women face multiple barriers in obtaining an accurate diagnosis. This constitutes a problem that needs to be addressed, and early appropriate medical care should be ensured. There are several effective treatment options for women with VWD that can significantly improve their quality of life, including desmopressin, VWF concentrates, hormonal therapy, and antifibrinolytic therapy. During pregnancy, the monitoring of VWF activity levels is essential. The peripartal management depends on the type of VWD and on the measured levels of VWF levels and activity prior to delivery.

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Section: Peripartal Managementmentioning

confidence: 99%

“…In patients with secondary PPH or heavy postpartum flow (patients who have to change their sanitary protection more often than every 2 hours), referral to a hematologist is essential to determine the VWF levels. TxA can be recommended in patients with heavy postpartum flow 8,51 and can be safely prescribed to breastfeeding women.…”

Section: Peripartal Managementmentioning

confidence: 99%

Von Willebrand Disease—Specific Aspects in Women

Eladly

Miesbach

2022

Hamostaseologie

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“…Prevention of PPH has to be tailored to the nature and the severity of the underlying maternal IBD. Tranexamic acid use should be considered systematically after vaginal or caesarean delivery as it lowers the risk of PPH in women with IBDs without a concurrent increase in the thrombotic risk 39 . In any case, women with IBDs should be followed for at least 2–3 weeks or longer postpregnancy such that delayed bleeding is recognized early and managed appropriately 33 …”

Section: Management Of Pregnancy and Post‐partum In Women With Ibdsmentioning

confidence: 99%

Big picture initiatives in bleeding disorders

et al. 2022

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Introduction:The inherited bleeding disorders (IBD) community has witnessed significant therapeutic advances recently, yet important gaps persist, particularly for those with rare disorders and historically underserved populations. Aims:-To create a national research blueprint agenda, led by the National Hemophilia Foundation (NHF), enhancing patient-centric principles, accelerate research progress and address important gaps in care.-To review critical gaps that remain to be addressed in women with IBDs, who face specific bleeding challenges. Methods:The NHF research blueprint research agenda was defined by input from across the community, including caregivers and patients who are considered subject matter experts of their IBD, research leaders, allied health professionals and specialists, and representatives of the biopharmaceutical industry. In addition, two medical experts in the field of IBDs performed a comprehensive review to address the knowledge gaps in women with IBDs.Results: Two foundational principles of the NHF blueprint are: (1) it must deliver on key issues that significantly impact the lives of those affected by IBDs, and (2) the priorities defined are relevant and actionable aimed to achieve health equity among all those affected by IBDs. A multidisciplinary approach is necessary for an optimal management of puberty, transition to adulthood and pregnancy. Even if strict guidelines are followed, recent studies show that women with IBDs are still facing a high burden.Conclusion: NHF blueprint will be issued in 2022. A specific research agenda is needed in women with IBDs to further improve their management and quality of life.

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“…78,79 It also lowers the risk of PPH in women with bleeding disorders and does not increase the risk of thrombosis after vaginal or cesarean delivery. [80][81][82] We prescribe tranexamic acid for at least 7 days postpartum for all women with bleeding disorders. After delivery, VWF and FVIII levels will gradually decrease to baseline levels within 3 weeks postpartum, and these women are prone to delayed bleeding in the puerperium.…”

Section: Managing Delivery In Women With Vwdmentioning

confidence: 99%

How I manage pregnancy in carriers of hemophilia and patients with von Willebrand disease

Leebeek¹,

Duvekot

Kruip³

2020

Blood

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Women with inherited bleeding disorders, including carriers of hemophilia A and B, or with von Willebrand disease, have an increased risk of bleeding during pregnancy and delivery. Also the unborn child may be affected by the bleeding disorder for which specific measures have to be considered. This requires a multi-disciplinary approach, including a hematologist, pediatric hematologist, clinical geneticist, obstetrician-perinatologist, and anesthesiologist. An optimal approach includes pre-pregnancy genetic counselling, prenatal diagnostic procedures, and making a treatment plan for delivery for both the mother and child. Recent retrospective studies show that even if strict guidelines are followed, these women are still at risk of postpartum bleeding. This occurs even in case of normalization of coagulation factor levels, either due to the pregnancy-induced rise of factor levels or by infusion of coagulation factor concentrates at the time of delivery. In this article we describe our current diagnostic and clinical management of pregnancy and delivery in women with inherited bleeding disorders. We also briefly discuss possible interventions to improve the outcome of current strategies by increasing target factor levels during and after delivery.

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Antifibrinolytic therapy for preventing VWD-related postpartum hemorrhage: indications and limitations

Cited by 7 publications

References 31 publications

Von Willebrand Disease—Specific Aspects in Women

Von Willebrand Disease—Specific Aspects in Women

Big picture initiatives in bleeding disorders

How I manage pregnancy in carriers of hemophilia and patients with von Willebrand disease

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