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May 6, 2009

Dexamethasone and Postoperative Bleeding After Tonsillectomy in Children

JAMA. 2009;301(17):1764-1766. doi:10.1001/jama.2009.574

To the Editor: The randomized trial by Dr Czarnetzki and colleagues1 suggested that dexamethasone decreased the risk of PONV but was associated with an increased risk of postoperative bleeding. The authors speculated that postoperative bleeding might be related to inhibition of repair processes of surgical wounds by glucocorticoids.

Therapeutic doses of dexamethasone (0.04 mg/kg and 1.0 mg/kg twice daily for 2 days) can increase the level of von Willebrand factor antigen (a specific endothelial cell product and marker of injury).2 There may be an inverse correlation between von Willebrand factor antigen levels and factor XIII (fibrin stabilizing factor), possibly due to consumption at the site of endothelial injury.3 Therefore, postoperative bleeding after dexamethasone treatment might be associated with decreased factor XIII levels, which have important roles in normal wound healing and hemostasis.

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