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

Authors: Eising, H. P.; Punt, M. C.; Leemans, J. C.; Bongers, M. Y.

Affiliations: Department of Gynaecology and Obstetrics, Gelre Hospital, Albert Schweitzerplein 31, 7334 DZ Apeldoorn, the Netherlands; Grow Research School Oncology and Reproduction, Maastricht University, the Netherlands. Department of Gynaecology and Obstetrics, Maxima Medical Center, Veldhoven, De Run 4600, 5504 DB Veldhoven, the Netherlands.

Publication: Blood reviews. 2023. 101131

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.