Fast Five Quiz: Bleeding Disorders

Emmanuel C. Besa, MD

Disclosures

July 11, 2019

According to guidelines from the National Institutes of Health and the National Heart, Lung, and Blood Institute, antifibrinolytic agents combined with desmopressin are generally effective for oral surgery in patients with mild to moderate von Willebrand disease. Von Willebrand factor should be available for patients who bleed excessively despite this treatment and for those who cannot receive desmopressin.

Prophylactic treatment with von Willebrand factor infusion is less frequently required among patients who have severe von Willebrand disease than among those who have severe hemophilia A. The risks and benefits must be considered on an individual basis when considering long-term therapy for patients with severe von Willebrand disease.

Desmopressin has been used to treat von Willebrand disease for more than 25 years. When administered intravenously, desmopressin increases plasma von Willebrand factor and factor VIII levels from twofold to more than fivefold over baseline levels. Desmopressin can also be administered intranasally or subcutaneously. The effective subcutaneous dose is equal to the intravenous dose.

Patients with von Willebrand disease should be advised to avoid aspirin, NSAIDs, and other drugs that inhibit platelet aggregation.

Read more on the treatment of von Willebrand disease.

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