Learning Objectives

  • Review data on peak factor VIII and von Willebrand factor activity levels recommended to minimize thrombotic risk in the perioperative setting

  • Compare pharmacologic profiles of von Willebrand factor/factor VIII concentrates used in a perioperative setting

  • Discuss venous thromboembolism prophylaxis strategies in patients with von Willebrand disease at elevated thrombotic risk

A 73-year-old man with mild type 1 von Willebrand disease (VWD), hypertension, type 2 diabetes mellitus, and history of recent ischemic stroke receiving daily aspirin 81 mg requires coronary artery bypass graft surgery for multivessel ischemic heart disease with unstable angina. Recent evaluation of his plasma von Willebrand factor (VWF) levels reveal VWF antigen level of 25%, ristocetin cofactor activity level of 19%, and factor VIII (FVIII) activity level of 30%. He is now referred for advice regarding a perioperative hemostatic management...

References

References
1.
Mannucci
PM
.
Venous thromboembolism in von Willebrand disease
.
Thromb Haemost
.
2002
;
88
(
3
):
378
-
379
.
2.
Makris
M
,
Colvin
B
,
Gupta
V
,
Shields
ML
,
Smith
MP
.
Venous thrombosis following the use of intermediate purity FVIII concentrate to treat patients with von Willebrand’s disease
.
Thromb Haemost
.
2002
;
88
(
3
):
387
-
388
.
3.
Girolami
A
,
Tezza
F
,
Scapin
M
,
Vettore
S
,
Casonato
A
.
Arterial and venous thrombosis in patients with von Willebrand’s disease: a critical review of the literature
.
J Thromb Thrombolysis
.
2006
;
21
(
2
):
175
-
178
.
4.
Gill
JC
,
Mannucci
PM
.
Thromboembolic incidence with transiently elevated levels of coagulation factors in patients with von Willebrand disease treated with VWF:FVIII concentrate during surgery
.
Haemophilia
.
2014
;
20
(
6
):
e404
-
e406
.
5.
Coppola
A
,
Franchini
M
,
Makris
M
,
Santagostino
E
,
Di Minno
G
,
Mannucci
PM
.
Thrombotic adverse events to coagulation factor concentrates for treatment of patients with haemophilia and von Willebrand disease: a systematic review of prospective studies
.
Haemophilia
.
2012
;
18
(
3
):
e173
-
e187
.
6.
Humphries
TJ
,
Ma
A
,
Kessler
CM
,
Kamalakar
R
,
Pocoski
J
.
A second retrospective database analysis confirms prior findings of apparent increased cardiovascular comorbidities in hemophilia A in the United States
.
Am J Hematol
.
2016
;
91
(
5
):
E298
-
E299
.
7.
Nichols
WL
,
Hultin
MB
,
James
AH
, et al
.
von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA)
.
Haemophilia
.
2008
;
14
(
2
):
171
-
232
.
8.
Alphanate [package insert]. Los Angeles, CA: Grifols Biologicals Inc; 2018
9.
Humate-P [package insert]. Marburg, Germany: CSL Behring GmbH; 2017
10.
Wilate [package insert]. Vienna, Austria: Octapharma Pharmazeutika Produktionsges; 2018
11.
Vonvendi [package insert]. Lexington, MA: Baxalta US Inc; 2018
12.
Srivastava
A
,
Serban
M
,
Werner
S
,
Schwartz
BA
,
Kessler
CM
;
Wonders Study Investigators
.
Efficacy and safety of a VWF/FVIII concentrate (Wilate®) in inherited von Willebrand disease patients undergoing surgical procedures
.
Haemophilia
.
2017
;
23
(
2
):
264
-
272
.
13.
Pashikanti
L
,
Von Ah
D
.
Impact of early mobilization protocol on the medical-surgical inpatient population: an integrated review of literature
.
Clin Nurse Spec
.
2012
;
26
(
2
):
87
-
94
.
14.
Kahn
SR
,
Lim
W
,
Dunn
AS
, et al
.
Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
.
Chest
.
2012
;
141
(
2 Suppl
):
e195S
-
e226S
.
15.
Chindamo
MC
,
Marques
MA
.
Papel da deambulação na prevenção do tromboembolismo venoso em pacientes clínicos: onde estamos? [Role of ambulation to prevent venous thromboembolism in medical patients: where do we stand?]
J Vasc Bras
.
2019
;
18
:
e20180107
.
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