23 Systematic review Figure 1: Prisma flow chart for identifying eligible studies on prophylactic and therapeutic strategies for intraoperative bleeding in von Willebrand disease women undergoing endometrial ablation or hysterectomy for heavy menstrual bleeding. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. Two of the included 12 studies described both EA and hysterectomy treatment in VWD women with HMB. (20, 22) Each of the included 12 studies reported different outcome criteria concerning HMB; the amount of blood loss during menstruation in milliliter, through hemoglobin levels or HMB being objectified by the standard pictorial blood assessment chart (PBAC). Duration of patient follow-up varied from 6 up to 73 months after treatment or was not specified. No study compared (post)operative bleeding events during hysterectomy or EA between women with VWD and the healthy population. The methodological heterogeneity of the surgical procedures hampered data pooling and meta-analysis. Records identified from Databases (n = 1102) Records removed before screening: Duplicate records removed (n = 12) Records excluded (n = 834) - No bleeding disorder (n = 532) - No endometrial ablation or hysterectomy (n = 221) - Oncology (n = 81) Reports excluded (n = 244): - Review (n = 24) - Protocol (n = 1) - No von Willebrand Disease patients (n = 161) - No endometrial ablation or hysterectomy (n = 42) - No predescribed outcome (complication/pretreatment) (n = 16) Identification Identification of studies via databases and registers Records screened (n = 1090) Screening Reports assessed for eligibility (n = 256 ) Studies included in review (n = 12) Included 2
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