Suggested VWD management strategies
| Type of bleeding . | Target VWF:RCo / FVIII level (IU/dL) . | DDAVP responsive . | DDAVP nonresponsive . | Adjunctive therapies . |
|---|---|---|---|---|
| Acute bleeding | ||||
| Minor | >30 IU/dL | TA ± DDAVP | TA ± VWF concentrate | |
| Major (life threatening) | ≈100 IU/dL | TA + VWF concentrate | TA + VWF concentrate | Consider platelets if bleeding persists |
| Surgery | ||||
| Minor | >30 IU/dL until healing complete | Pre-op: TA; IV DDAVP | Pre op: TA + VWF concentrate | |
| Post-op: TA for 3-5 d | Post-op: TA for 3-5 d | |||
| Major | ≈100 IU/dL until 36 h post-op | Pre-op: TA; IV DDAVP | Pre-op: TA + VWF | |
| Maintain >50 IU/dL for 5-10 d | May require VWF concentrate if tachyphylaxis | concentrate | ||
| Dental extraction | >50 IU/dL for 12 h | Pre: DDAVP | Pre: VWF concentrate | |
| Post: TA for 3 d | Post: TA for 3 d | |||
| Menorrhagia | TA to cover days of heaviest flow | TA to cover days of heaviest flow | OCP | |
| Monthly intranasal DDAVP | Levonorgestrel intrauterine device (Mirena) | |||
| Iron supplementation | ||||
| Endometrial ablation | ||||
| Hysterectomy |
| Type of bleeding . | Target VWF:RCo / FVIII level (IU/dL) . | DDAVP responsive . | DDAVP nonresponsive . | Adjunctive therapies . |
|---|---|---|---|---|
| Acute bleeding | ||||
| Minor | >30 IU/dL | TA ± DDAVP | TA ± VWF concentrate | |
| Major (life threatening) | ≈100 IU/dL | TA + VWF concentrate | TA + VWF concentrate | Consider platelets if bleeding persists |
| Surgery | ||||
| Minor | >30 IU/dL until healing complete | Pre-op: TA; IV DDAVP | Pre op: TA + VWF concentrate | |
| Post-op: TA for 3-5 d | Post-op: TA for 3-5 d | |||
| Major | ≈100 IU/dL until 36 h post-op | Pre-op: TA; IV DDAVP | Pre-op: TA + VWF | |
| Maintain >50 IU/dL for 5-10 d | May require VWF concentrate if tachyphylaxis | concentrate | ||
| Dental extraction | >50 IU/dL for 12 h | Pre: DDAVP | Pre: VWF concentrate | |
| Post: TA for 3 d | Post: TA for 3 d | |||
| Menorrhagia | TA to cover days of heaviest flow | TA to cover days of heaviest flow | OCP | |
| Monthly intranasal DDAVP | Levonorgestrel intrauterine device (Mirena) | |||
| Iron supplementation | ||||
| Endometrial ablation | ||||
| Hysterectomy |
OCP, oral contraceptive pill; TA, tranexamic acid.