Hemostatic agents
The different hemostatic agents used for treatment of bleeding and/or handling different clinical procedures in VWD patients include the following drugs:
Desmopressin (DDAVP)
VWF concentrates
Tranexamic acid
Oral contraceptive pills and IUD
Choice of treatment
The choice of treatment depends on several factors:
Nature of the bleed or invasive procedure.
Subtype and severity of VWD - level of functional VWF and FVIII.
Previous bleeding history and response to treatment.
Duration of treatment - single doses or a long-term treatment.
Outcome of the DDAVP test - post DDAVP level and half-life of functional VWF and FVIII.Age of the patient. Restricted use of DDAVP is advised in frail elderly and the youngest children of less than 2 years of age - due to increased risk symptomatic hyponatremia in and an increased risk of thrombotic complications in patients with cardiovascular risk factors, including high age.
The presence of other diseases that may contraindicate use of a therapeutic agent.
Pregnancy and delivery.
Suggested treatment options are given in Figure 1, in the text below and in appendix 1.