Page 212 - 2020_07-Haematologica-web

F. Paciullo et al.
LMWH use was neither associated with an increased rate of excessive post-surgical bleeding nor with enhanced need for post-surgical antihemorrhagic intervention. Also the use of preoperative anti-hemorragic prophylaxis was similar in patients treated or not with LMWH. Thus, our results suggest that thromboprophylaxis with LMWH may be safer than anticipated in IPD patients. On the other hand, it should be pointed out that although LMWH did not significantly affect the success rate of emergency treatment of post-surgical bleeding, a numerically higher number of insuccess was observed in patients treated with LMWH. Thus, caution should be used when deciding about LMWH prophylaxis for IPD patients, especially for those at higher bleeding risk (e.g. more severe forms and/or patients with higher WHO bleeding scores). The use of post-surgical thromboprophylaxis with LMWH and the rate of VTE were similar between elective and urgent procedures, while the rate of excessive post-surgical bleeding was higher in urgent than in elective procedures, as expected.
Our study has several limitations. First, we only looked for symptomatic VTE, thus the incidence of total VTE may have been significantly underestimated due to the lack of a systematic instrumental diagnostics search of these events during post-surgical follow-up. Indeed, no calf or distal vein thrombosis was reported and the latter could have been overlooked, due to the low clinical expressivity and difficulty of diagnosis. However, the pos- sible underestimation of distal DVT may not significantly diminish the clinical relevance of our observations because untreated distal DVT is associated with a low risk of proximal propagation and PE.32 Second, the retrospec- tive nature of our study does not allow for definitive con- clusions about the impact of heparin use on bleeding in patients with IPD. However, the collection of hemorrhag- ic post-surgical events was the main aim of our study and great emphasis was given to the careful evaluation of their occurrence. Moreover, the observational multicenter nature of our study, as already observed for other reg- istries of populations with VTE, allowed us to gather a
A
B
Figure 2. Use of low molecular weight heparin in inherited platelet disorder patients according to venous thromboembolism risk classes. Use of LMWH in IPD patients according to A) Caprini VTE class risk and B) procedure related VTE- risk (*P<0.01 vs. high-risk). LMWH: low molecular weight heparin; IPD: inherited platelet disorder; VTE: venous thromboembolism.
Figure 3. Use of thrombo- prophylaxis according to date of surgery (*P<0.01 vs. 2010-2017). Seven pro- cedures (3.3% of total) were carried out ≤1980.
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haematologica | 2020; 105(7)