von Willebrand disease (VWD) is the most common bleeding disorder and especially milder type 1 VWD might not be cared for in specialty clinics. VW factor levels rise with age, but the rise of these levels does not necessarily correlate with bleeding risk. A recent bleeding history combined with recent labs are important for hemostatic management decision during surgical interventions. Antifibrinolytics appear safe in the population of older adults, whereas desmopressin (DDAVP) should be used cautiously. Where needed, factor concentrates present a great treatment option. Acquired von Willebrand syndrome is vastly underrecognized, but likely to surface in the aging, especially in the setting of comorbidities, such as plasma-cell dyscrasias. Intravenous immunoglobulin can be an effective treatment in this scenario, but potentially increases thrombotic risk.
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GERIATRIC HEMATOLOGY|
January 18, 2024
How I treat von Willebrand disorders in older adults
Jacqueline N. Poston,
Jacqueline N. Poston
1Division of Hematology/Oncology, Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT
2Division of Clinical Pathology, Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT
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Rebecca Kruse-Jarres
Rebecca Kruse-Jarres
3Washington Center for Bleeding Disorders, Seattle, WA
4Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
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Blood (2024) 143 (3): 197–204.
Article history
Submitted:
November 7, 2022
Accepted:
July 10, 2023
First Edition:
September 6, 2023
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Citation
Jacqueline N. Poston, Rebecca Kruse-Jarres; How I treat von Willebrand disorders in older adults. Blood 2024; 143 (3): 197–204. doi: https://doi.org/10.1182/blood.2022018534
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