Clinical scenarios encountered in the management of patients with low VWF
| . | Alternate clinical scenarios . | Clinical assessment . | Suggested management strategy . |
|---|---|---|---|
| Case 1 | 22-y-old male with low VWF | Assess personal and family bleeding history | Single dose of DDAVP before DE |
| Baseline plasma VWF:Ag, 35 IU/dL; VWF:RCo, 32 IU/dL | Calculate ISTH BAT score | If no previous record of DDAVP response, assess plasma VWF levels at baseline and 1, 2, and 4 h post-DDAVP | |
| Requires a surgical molar DE | Determine whether the patient has previously been treated for any procedures with tranexamic acid and/or DDAVP | Tranexamic acid, 1 g, 3 times a day for 3-5 d postprocedure | |
| Contact details in case of bleeding | |||
| Case 2 | 65-y-old with history of low VWF levels | Assess personal and family bleeding history | Treatment plan will be based upon global risk assessment for bleeding and thrombotic potential |
| Baseline plasma VWF:Ag, 32 IU/dL; VWF:RCo, 30 IU/dL | Calculate ISTH BAT score | If risk of stroke outweighs bleeding risk, consider introduction of anticoagulation with regular ongoing follow-up at 3 monthly intervals to reassess | |
| More recent plasma VWF:Ag and VWF:RCo levels now consistently >50 IU/dL | Consider any comorbidities/medications that may contribute to current bleeding risk | Provide contact details in case of bleeding | |
| Has developed persistent atrial fibrillation | Determine CHA2DS2-VASc score to assess risk of CVA | ||
| Case 3 | 70-y-old woman with low VWF levels | Assess personal and family bleeding history | If elevated bleeding history, treat with tranexamic acid cover (1 g preoperatively and 1 g, 3 times a day postoperatively for 48-72 h |
| Baseline plasma VWF:Ag, 40 IU/dL; VWF:RCO, 44 IU/dL | Calculate ISTH BAT score | Daily review by Coagulation Service to determine when tranexamic acid can be discontinued and LMWH introduced. Thromboembolic Deterrent Stockings. | |
| More recent plasma VWF levels consistently >70 IU/dL | Consider any comorbidities/medications that may contribute to current bleeding or thrombotic risks | Early mobilization as surgically appropriate | |
| Requires elective total knee replacement |
| . | Alternate clinical scenarios . | Clinical assessment . | Suggested management strategy . |
|---|---|---|---|
| Case 1 | 22-y-old male with low VWF | Assess personal and family bleeding history | Single dose of DDAVP before DE |
| Baseline plasma VWF:Ag, 35 IU/dL; VWF:RCo, 32 IU/dL | Calculate ISTH BAT score | If no previous record of DDAVP response, assess plasma VWF levels at baseline and 1, 2, and 4 h post-DDAVP | |
| Requires a surgical molar DE | Determine whether the patient has previously been treated for any procedures with tranexamic acid and/or DDAVP | Tranexamic acid, 1 g, 3 times a day for 3-5 d postprocedure | |
| Contact details in case of bleeding | |||
| Case 2 | 65-y-old with history of low VWF levels | Assess personal and family bleeding history | Treatment plan will be based upon global risk assessment for bleeding and thrombotic potential |
| Baseline plasma VWF:Ag, 32 IU/dL; VWF:RCo, 30 IU/dL | Calculate ISTH BAT score | If risk of stroke outweighs bleeding risk, consider introduction of anticoagulation with regular ongoing follow-up at 3 monthly intervals to reassess | |
| More recent plasma VWF:Ag and VWF:RCo levels now consistently >50 IU/dL | Consider any comorbidities/medications that may contribute to current bleeding risk | Provide contact details in case of bleeding | |
| Has developed persistent atrial fibrillation | Determine CHA2DS2-VASc score to assess risk of CVA | ||
| Case 3 | 70-y-old woman with low VWF levels | Assess personal and family bleeding history | If elevated bleeding history, treat with tranexamic acid cover (1 g preoperatively and 1 g, 3 times a day postoperatively for 48-72 h |
| Baseline plasma VWF:Ag, 40 IU/dL; VWF:RCO, 44 IU/dL | Calculate ISTH BAT score | Daily review by Coagulation Service to determine when tranexamic acid can be discontinued and LMWH introduced. Thromboembolic Deterrent Stockings. | |
| More recent plasma VWF levels consistently >70 IU/dL | Consider any comorbidities/medications that may contribute to current bleeding or thrombotic risks | Early mobilization as surgically appropriate | |
| Requires elective total knee replacement |
CVA, cerebrovascular accident; LMWH, low molecular weight heparin.