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Dextran 40-Induced Coagulopathy Confused With von Willebrand Disease

Dextran 40-Induced Coagulopathy Confused With von Willebrand Disease Abstract • In a patient who had undergone reconstructive surgery on the subclavian artery and was treated postoperatively with aspirin and dextran 40, a bleeding diathesis developed within 24 hours. This was at first thought to be von Willebrand disease, since the bleeding time was longer than ten minutes; the factor VIII level, 28%; and the activated partial thromboplastin time, 50 seconds (normal 30 to 38). The patient's defect responded to discontinuance of the low-molecular-weight, dextran and aspirin therapy and administration of a cryoprecipitate. Later studies of the coagulation mechanism up to two and one-half months were entirely normal. The postoperative defect therefore was assumed to have been the result of the administration of dextran and aspirin. It is possible that in a similar future case, discontinuance of dextran infusion and administration of a single bolus of 12 bags of cryoprecipitate may be adequate treatment. (Arch Surg 112:321-322, 1977) References 1. Weiss HJ: The effect of clinical dextran on platelet aggregation, adhesion, and ADP release in man: In vivo and in vitro studies . J Lab Clin Med 69:37-46, 1967. 2. Williams JW, Beutler E, Erslev AJ, et al: Hematology New York, McGraw-Hill Book Co Inc, 1972. 3. Hardisty RM, Ingram GIC: Bleeding Disorders: Investigation and Management . Philadelphia, FA Davis Co, 1965. 4. Ratnoff OD: On hemorrhagic disorders . Hospital Physician , (January) 1975, pp 28-39. 5. Howard MA, Firkin BG: Ristocetin: A new tool in the investigation of platelet aggregation . Thromb Diath Haemorrh 26:362-369, 1971. 6. Mielke CH Jr, Kaneshiro MM, Maher IA, et al: The standardized normal ivy bleeding time and its prolongation by aspirin . Blood 34:204-215, 1969. 7. Berliner AD, Lackner H: Hemorrhagic diathesis after prolonged infusion of low molecular weight dextran . Am J Med Sci 263:397-403, 1972.Crossref 8. Nilsson IM, Eiken O: Further studies on the effect of dextran of various molecular weight on the coagulation mechanism . Thromb Diath Haemorrh 11:38-48, 1964. 9. Langdell RD, Adelson E, Furth FW, et al: Dextran and prolonged bleeding time: Results of a 60-gm, 1-liter infusion given to 163 normal human subjects . JAMA 166:346-351, 1958.Crossref 10. Bygdeman S, Eliosson R: Effect of dextrans on platelet adhesiveness and aggregation . Scand J Clin Lab Invest 20:17-31, 1967.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Dextran 40-Induced Coagulopathy Confused With von Willebrand Disease

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Publisher
American Medical Association
Copyright
Copyright © 1977 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1977.01370030093016
Publisher site
See Article on Publisher Site

Abstract

Abstract • In a patient who had undergone reconstructive surgery on the subclavian artery and was treated postoperatively with aspirin and dextran 40, a bleeding diathesis developed within 24 hours. This was at first thought to be von Willebrand disease, since the bleeding time was longer than ten minutes; the factor VIII level, 28%; and the activated partial thromboplastin time, 50 seconds (normal 30 to 38). The patient's defect responded to discontinuance of the low-molecular-weight, dextran and aspirin therapy and administration of a cryoprecipitate. Later studies of the coagulation mechanism up to two and one-half months were entirely normal. The postoperative defect therefore was assumed to have been the result of the administration of dextran and aspirin. It is possible that in a similar future case, discontinuance of dextran infusion and administration of a single bolus of 12 bags of cryoprecipitate may be adequate treatment. (Arch Surg 112:321-322, 1977) References 1. Weiss HJ: The effect of clinical dextran on platelet aggregation, adhesion, and ADP release in man: In vivo and in vitro studies . J Lab Clin Med 69:37-46, 1967. 2. Williams JW, Beutler E, Erslev AJ, et al: Hematology New York, McGraw-Hill Book Co Inc, 1972. 3. Hardisty RM, Ingram GIC: Bleeding Disorders: Investigation and Management . Philadelphia, FA Davis Co, 1965. 4. Ratnoff OD: On hemorrhagic disorders . Hospital Physician , (January) 1975, pp 28-39. 5. Howard MA, Firkin BG: Ristocetin: A new tool in the investigation of platelet aggregation . Thromb Diath Haemorrh 26:362-369, 1971. 6. Mielke CH Jr, Kaneshiro MM, Maher IA, et al: The standardized normal ivy bleeding time and its prolongation by aspirin . Blood 34:204-215, 1969. 7. Berliner AD, Lackner H: Hemorrhagic diathesis after prolonged infusion of low molecular weight dextran . Am J Med Sci 263:397-403, 1972.Crossref 8. Nilsson IM, Eiken O: Further studies on the effect of dextran of various molecular weight on the coagulation mechanism . Thromb Diath Haemorrh 11:38-48, 1964. 9. Langdell RD, Adelson E, Furth FW, et al: Dextran and prolonged bleeding time: Results of a 60-gm, 1-liter infusion given to 163 normal human subjects . JAMA 166:346-351, 1958.Crossref 10. Bygdeman S, Eliosson R: Effect of dextrans on platelet adhesiveness and aggregation . Scand J Clin Lab Invest 20:17-31, 1967.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Mar 1, 1977

References