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Intraoperative Hemostatic Management of A Patient with type 3 vWD Undergoing CABG
Poster Title: Intraoperative Hemostatic Management of A Patient with type 3 vWD Undergoing CABG
Submitted on 09 Jul 2018
Author(s): Darius Jamschidian, MD, Surbhi Mathur, MBBS, Timothy Del Rosario, MD, Ankit Jain, MBBS
Affiliations: Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia
This poster was presented at Georgia Society of Anesthesiologist
Poster Views: 318
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Poster Information
Abstract: Open heart surgery is a major challenge in patients suffering from inherited bleeding disorders such as von Willebrand Disease.
Here we describe the intraoperative hemostatic management of a 73-year-old Caucasian male with a history of vWD who was found to have significant multi-vessel coronary artery disease and underwent cardiothoracic surgery for open revascularization.
Arriving at a specific diagnosis of vWD was crucial in formulating a perioperative strategy. The approach in this setting was to optimize vWF and FVIII levels in the preoperative, intraoperative, as well as postoperative periods. The administration of Humate P was also central to this plan.
Throughout the case, no significant bleeding of any type was observed and the postoperative course was unremarkable. The patient was discharged on postoperative day 8.
Summary: Von Willebrand factor (vWF) is a multimeric protein produced by platelets and endothelial cells that is stored within granules. In most subtypes of vWD, the cornerstone of treatment involves the administration of DDAVP (desmopressin).
Here we describe the importance of formulating a systematic approach for the intraoperative hemostatic management of a patient with type III vWD undergoing open heart surgery.
References: 1. Veyradier A, Jenkins CS, Fressinaud E, Meyer D. Acquired von Willebrand syndrome: from patho-physiology to management. Thromb Haemost 2000;84:175-182
2. Teppone-Martin OL, Zhao M, Norris TE. von Willebrand disease and cardiopulmonary bypass: a case report. AANA J 2013;81:60-64
3. Lee JW. von Willebrand disease, hemophilia A and B, and other factor deficiencies. Int Anesthesiol Clin. 2004;42(3):59-76
4. Federici AB. The safety of plasma-derived von Willebrand/factor VIII concentrates in the management of inherited von Willebrand disease. Expert Opin Drug Saf. 2009;8(2):203-210
5. Mannucci PM, Cattaneo M. Desmopressin: a nontransfusional treatment of hemophilia and von Willebrand disease. Haemostasis 1992;22:276-280
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