Background: Bleeding symptoms in von Willebrand disease (VWD) may be minimal in the absence of hemostatic stressors, such as menstruation and childbirth; thus, patients seeking medical care for VWD are often younger. As a result, the natural course of VWD in older adults has not been well described.

Aims: To perform a descriptive analysis of older VWD patients receiving care at our Hemophilia Treatment Center (HTC).

Methods: We performed a retrospective electronic health record review of VWD patients with at least 1 HTC clinic visit between June 1, 2015, and May 31, 2021, and age 45 or older at the time of the visit. Data collected consisted of demographics; VWD-related information; multimorbidity; and medications. A paired t-test was performed to compare change in von Willebrand factor (VWF) levels and bleeding score, and McNemar’s test was used to compare change in the proportion of patients with normal VWF levels and bleeding score. Multiple linear regression was performed to assess the influence of multimorbidity on change in VWF levels adjusted for VWD type.

Results: Seventy patients had 131 HTC clinic visits with an average of 1.9 (SD 1.3, range 1-9) visits per person. Patient characteristics are presented in Table 1. Among 62 invasive procedures in 36 patients (Table 1), nine were performed without VWD-specific therapy. Bleeding occurred with two procedures, a colonoscopy with desmopressin and a spine surgery without VWD-specific therapy. Mean baseline VWF levels and bleeding score were normal, and VWF levels increased with age in patients with type 1 VWD (Table 2). Multimorbidity did not predict change in VWF levels, beta=0.044 (SE 0.047), p=0.36.

Conclusion(s): Our findings underscore the importance of describing the natural course of VWD in older adults, especially the critical nature of determining bleeding risk in this population, to guide clinical decision-making with the use of antihemostatic drugs and periprocedural VWD-specific therapy.

Table

Patient characteristics

Table

Change in von willebrand factor levels and bleeding score

« Back to ISTH 2022 Congress

ISTH Congress Abstracts - https://abstracts.isth.org/abstract/von-willebrand-disease-in-older-patients/