Risk of excessive bleeding associated with marginally low von Willebrand factor and mild platelet dysfunction
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CitationJ Thromb Haemost. 2007:5(2):274-81
AbstractBackground: Bleeding symptoms are so commonly reported that it is not known whether they associate causally or coincidentally with mild but measureable primary hemostatic defects. Objectives/Patients/Methods: In order to evaluate if the mild primary hemostatic defects are truly causative of increased bleeding symptoms, we surveyed a population of healthy teenagers for bleeding symptoms. Using a case-control approach, we then estimated the risk of excessive bleeding associated with low von Willebrand factor (defined as VWF below the 5th percentile of a normal reference population) or mild platelet dysfunction (PD, defined as concurrent reduced platelet aggregation responses to two agonists (ADP and epinephrine). Results: Excessive bleeding was present in 63 out of 809 teenagers (7.8%). Among the 49 cases who were tested for VWF, low values by three measures was more commonly present than in 166 controls, specifically, ristocetin cofactor activity (20.4% vs 5.4%, odds ratio 4.5), collagen binding (14.3% vs 4.2%, OR 3.8), and antigen level (20.4% vs 6.0%, OR 4.0). The low ristocetin cofactor values ranged from 35-45 U/dL except for a single case with 26 U/dL. Of the 47 teenagers with excessive bleeding who underwent platelet aggregation studies, reduced responses were more common than in controls (12.8% vs 4.4%, OR 3.2). Twenty nine percent of cases with excessive bleeding had either low ristocetin cofactor or PD. Conclusions: Almost one in three teenagers who report excessive bleeding are likely to have a measurable hemostatic disturbance manifested either by marginally low VWF (by three measures) or mild PD.
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