PERIOPERATIVE MANAGEMENT OF PATIENTS WITH VON WILLEBRAND DISEASE.pdf (394.31 kB)
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Perioperative management of patients with von Willebrand disease

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journal contribution
posted on 06.07.2021, 14:52 by James O'DonnellJames O'Donnell, Michelle LavinMichelle Lavin
Surgical procedures represent a serious hemostatic challenge for patients with von Willebrand disease (VWD), and careful perioperative management is required to minimize bleeding risk. Risk stratification includes not only the nature of the surgery to be performed but the baseline plasma vonWillebrand factor (VWF) levels, bleeding history, and responses to previous challenges. Baseline bleeding scores (BSs) may assist in identification of patients with a higher risk of postsurgical bleeding. There remains a lack of consensus between best practice guidelines as to the therapeutic target and assays to be monitored in the postoperative period. Hemostatic levels are maintained until bleeding risk abates: usually 3 to 5 days forminor procedures and 7 to 14 days formajor surgery. Hemostatic supplementation ismore complex in VWD than in other bleeding disorders owing to the combined but variable deficiency of both plasma VWF and factor VIII (FVIII) levels. For emergency surgery, coadministration of VWF and FVIII is required to ensure hemostasis; however, for elective procedures, early infusion of VWF replacement therapy will stabilize endogenous FVIII. Because endogenous FVIII production is unaffected in patients with VWD, repeated VWF supplementation (particularly with plasma-derived FVIII-containing products) may lead to accumulation of FVIII. Frequent monitoring of plasma levels and access to hemostatic testing are, therefore, essential for patients undergoing major surgery, particularly with more severe forms of VWD.

History

Comments

This research was originally published in O'Donnell JS, Lavin M. Perioperative management of patients with von Willebrand disease. Hematology Am Soc Hematol Educ Program. 2019;2019(1):604-609. © the American Society of Hematology.

Published Citation

O'Donnell JS, Lavin M. Perioperative management of patients with von Willebrand disease. Hematology Am Soc Hematol Educ Program. 2019;2019(1):604-609.

Publication Date

6 December 2019

PubMed ID

31808837

Department/Unit

  • Irish Centre for Vascular Biology
  • School of Pharmacy and Biomolecular Sciences

Research Area

  • Vascular Biology
  • Gynaecology, Obstetrics and Perinatal Health

Publisher

American Society of Hematology

Version

  • Accepted Version (Postprint)