Adjunctive and rescue treatments for VWD-associated GI bleeding
| Treatment . | Time course . | Mechanism . | Notes . |
|---|---|---|---|
| High-dose statins11 | Nonacute | Antiangiogenic | |
| Bevicizumab11 | Nonacute | Decreases angiogenesis by acting as humanized monoclonal antibody against VEGF | Also used in HHT; bleeding risk |
| Octreotide11 | Acute and prophylactic management | Decreased splanchnic blood flow and improved platelet aggregation | |
| Thalidomide11,24 | Nonacute | Antiangiogenic | Based on limited data, appears less effective than lenalidomide |
| Lenalidomide42 | Nonacute, up titration as needed, potential for long-term control | Antiangiogenic | |
| Estrogen/progesterone43 | Acutely | Stimulation of ECs to increase VWF | Potential thrombotic side effects |
| Tamoxifen44 | Nonacute | Antiangiogenic | Also used in HHT |
| Steroids (including danazol)11 | Acutely | Increase in FVIII levels | Often transient effect, potentially toxic to the liver |
| β blockers (usually nonselective, such as propranolol) | Both acutely and prophylactically | Blood flow redistribution | Usually accompanied by octreotide |
| Treatment . | Time course . | Mechanism . | Notes . |
|---|---|---|---|
| High-dose statins11 | Nonacute | Antiangiogenic | |
| Bevicizumab11 | Nonacute | Decreases angiogenesis by acting as humanized monoclonal antibody against VEGF | Also used in HHT; bleeding risk |
| Octreotide11 | Acute and prophylactic management | Decreased splanchnic blood flow and improved platelet aggregation | |
| Thalidomide11,24 | Nonacute | Antiangiogenic | Based on limited data, appears less effective than lenalidomide |
| Lenalidomide42 | Nonacute, up titration as needed, potential for long-term control | Antiangiogenic | |
| Estrogen/progesterone43 | Acutely | Stimulation of ECs to increase VWF | Potential thrombotic side effects |
| Tamoxifen44 | Nonacute | Antiangiogenic | Also used in HHT |
| Steroids (including danazol)11 | Acutely | Increase in FVIII levels | Often transient effect, potentially toxic to the liver |
| β blockers (usually nonselective, such as propranolol) | Both acutely and prophylactically | Blood flow redistribution | Usually accompanied by octreotide |
HHT, hereditary hemorrhagic telangiectasia.