Abstract Number: PB1593
Meeting: ISTH 2020 Congress
Theme: Platelet Disorders and von Willebrand Disease » VWF and von Willebrand Factor Disorders - Clinical Conditions
Background: Perioperative replacement of von Willebrand factor (VWF) can be challenging if only plasma-derived factor VIII/VWF concentrates are available. They present different FVIII/VWF ratios (1:1 and 1:2) that must be taken into account. In order to maintain the desired VWF activity sometimes FVIII (FVIII:C) levels surpass 150%, increasing the risk of thrombosis. Although the Brazilian guidance on von Willebrand disease (VWD) recommends daily monitoring only of coagulation factor VIII:C, some authors abroad have included von Willebrand factor activity (VWF:RCo) as a relevant parameter during the post-operative period.
Aims: To check the relevance of VWF:RCo and FVIII:C to guide VWF replacement and investigate their correlation with bleeding or thrombosis in the perioperative period.
Methods: Data of all patients with the diagnosis of VWD and submitted to an invasive procedure at HCFMUSP between 2008 and 2018 were collected whenever available and complete. VWF was replaced with FVIII/VWF plasma derived concentrates, according to the Brazilian guidance. Recombinant FvW is not available in Brazil. Results are described.
Results: Data of 10 patients were collected. They were predominantly female (70%) and adults (mean age = 46 years). Only 1 patient presented VWD type 3, the others being equally distributed between types 1 (n=4) and 2 (n=5). Fourteen procedures were studied, most of them major (n=9) and the others, minor. All patients achieved the desired levels of FVIII:C and no thrombosis ocurred, even in 2 patients with FVIII:C higher than 150%. Low levels of VWF had no correlation with bleeding, except in 1 patient with FVIII:C of 111%. Decisions on VWF replacement were based on the presence of bleeding and FVIII:C levels, since results of VWF:RCo were not always available at the time of prescriptions.
Conclusions: Perioperative VWF replacement was guided by FVIII:C levels and the presence of bleeding and was independent of FvW:RCo levels in the procedures studied.
To cite this abstract in AMA style:
Rothschild C, Siqueira DB, Okazaki E, Villaca PR, Rocha TRF, Rocha V. Laboratory Monitoring of Perioperative von Willebrand Factor Replacement [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/laboratory-monitoring-of-perioperative-von-willebrand-factor-replacement/. Accessed March 21, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/laboratory-monitoring-of-perioperative-von-willebrand-factor-replacement/