Canterbury DHB

Context

Surgery and Major Bleeds

For patients with mild Type I von Willebrand's disease, desmopressin with or without Tranexamic Acid is usually satisfactory for bleeding episodes and for many surgical procedures.

Patients with more severe Type I or Type II and in particular, Type III, usually require the infusion of normal von Willebrand factor. Currently, this is available in concentrates of plasma-derived factor VIII (the CSL biostate vial contains 250 or 500 units of factor VIII and 500 or 1000 units respectively of VWF cofactor activity).

Recombinant factor VIII products are not suitable.

Von Willebrand factor concentrates without factor VIII are not currently available in N.Z.

The actual dose recommendations in the literature are quite varied. Because the factor VIII level is a major determinant of operative bleeding, and because of the ease of assay of factor VIII, the factor VIII concentration, not von Willebrand factor levels, is used in dosage schedules and to monitor treatment. In major surgery it is advisable to supplement the factor VIII levels with ristocetin cofactor assays if possible, and/or monitor platelet activity with a PFA-100 analysis which is sensitive to the von Willebrand factor defect.

See the Desmopressin Data Sheets on Medsafe for dosage, precautions, side effects and contraindications.

About this Canterbury DHB document (5278):

Document Owner:

Mark Smith (see Who's Who)

Issue Date:

August 2016

Next Review:

August 2019

Keywords:

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Topic Code: 5278