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...

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