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Federici AB. Current Diagnosis of von Willebrand Disease in Italy: 3 Years Following the Release of the International Guidelines. Semin Thromb Hemost 2024. [PMID: 38950597 DOI: 10.1055/s-0044-1787841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
The American Society of Hematology-International Society on Thrombosis and Haemostasis-National Hemophilia Foundation-World Federation of Hemophilia 2021 International Guidelines (IGL) on von Willebrand disease (VWD) have pointed out many challenges, mainly in the diagnostic approach of VWD patients. To determine the impact of these IGL on the current clinical and laboratory diagnosis of Italian VWD patients, we have recently conducted a survey among 43 centers affiliated with the Italian Association of Hemophilia Centers (AICE). Directors and colleagues responsible for the management of VWD patients were invited to report in a detailed questionnaire how IGL recommendations about the assessment of the specific activities of von Willebrand Factor (VWF) could be applied at their local sites. Results from such a survey showed that bleeding assessment tools, VWF antigen, and factor VIII procoagulant are currently in use in all centers. The automated assays for platelet-dependent VWF activity with or without ristocetin described in IGL have been used since 2021 in 37/43 (86%) centers. Among other laboratory tests, VWF collagen binding, ristocetin-induced platelet agglutination, multimeric analysis, VWF propeptide, VWF:FVIII binding assay were available in 49, 63, 26, 7, and 28% of AICE, respectively. Analyses of VWF gene defects are available only at 3/43 (7%) centers. Desmopressin (DDAVP) infusion trials at diagnosis, with measurements of VWF activities at 1 and 4 hours post-DDAVP, is currently performed at 38/43 (88%) centers. Based on this information, a simplified clinical diagnosis using a few automated tests before and after DDAVP has been proposed. Such a diagnostic approach will be validated prospectively in a large cohort of Italian VWD patients.
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Affiliation(s)
- Augusto B Federici
- Hematology and Transfusion Medicine, School of Medicine of the University of Milan, L. Sacco University Hospital, Milan, Italy
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2
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Haginoya S, Thomovsky EJ, Johnson PA, Brooks AC. Clinical Assessment of Primary Hemostasis: A Review. Top Companion Anim Med 2023; 56-57:100818. [PMID: 37673175 DOI: 10.1016/j.tcam.2023.100818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 09/08/2023]
Abstract
Primary hemostatic disorders such as thrombocytopenia and thrombocytopathia are commonly encountered in small animal practice. The key stages of primary hemostasis include platelet adhesion, activation, and aggregation. Understanding the interaction between tissues, platelets, and signaling molecules not only helps clinicians comprehend clot formation but also better recognize thrombocytopathias. Although congenital thrombocytopathia is rare, commercially available platelet function tests allow veterinarians to narrow differentials in many clinical settings. Thrombocytopenia can be easily diagnosed in any clinical setting. In this paper, we review the current understanding of primary hemostasis in veterinary medicine, including the clinical presentation and available diagnostics to identify platelet abnormalities.
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Affiliation(s)
- Satoshi Haginoya
- Purdue University College of Veterinary Medicine, West Lafayette, IN, USA.
| | | | - Paula A Johnson
- Purdue University College of Veterinary Medicine, West Lafayette, IN, USA
| | - Aimee C Brooks
- Purdue University College of Veterinary Medicine, West Lafayette, IN, USA
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3
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Miljic P, Noureldin A, Lavin M, Kazi S, Sanchez-Luceros A, James PD, Othman M. Challenges in the management of women with type 2B von Willebrand disease during pregnancy and the postpartum period: evidence from literature and data from an international registry and physicians' survey-communication from the Scientific and Standardization Committees of the International Society on Thrombosis and Haemostasis. J Thromb Haemost 2023; 21:154-163. [PMID: 36695378 DOI: 10.1016/j.jtha.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Management of women with type 2B von Willebrand disease (VWD) during pregnancy is challenging because of dysfunctional von Willebrand factor (VWF) and the complexity resulting from discrepant VWF/factor VIII (VWF/FVIII) levels, impaired platelet-dependent VWF activity, progressive thrombocytopenia, and risks associated with the use of desmopressin. There is a lack of high-quality evidence to support clinical decision making. OBJECTIVES In this study, we examined the current diagnostic and management approaches and outcomes in women with VWD during pregnancy. METHODS Data were collected via 3 avenues: literature review, an international registry, and an international survey on physicians' practices for the management of pregnancy in women with VWD. The registry and survey were supported by the International Society on Thrombosis and Haemostasis. RESULTS Data on clinical and laboratory features, management and bleeding complications, and pregnancy outcomes of a total of 55 pregnancies from 49 women across the globe (literature: 35, registry: 20) and data reported by 112 physicians were analyzed. We describe the largest dataset on pregnancies in women with type 2B VWD available to date. The data highlight the following key issues: a) bleeding complications remain a concern in these patients, b) the target safe VWF level and the ideal monitoring approach are unknown, c) there is a wide range of hemostatic management practices in the type and timing of treatment, and d) physicians have diverse views on the mode of delivery and use of neuraxial anesthesia. CONCLUSION We conclude that an international consensus and guidance are critically required for better care and improved outcomes in this patient cohort.
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Affiliation(s)
- Predrag Miljic
- Clinic of Haematology, University Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Abdelrahman Noureldin
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Michelle Lavin
- National Coagulation Centre, St. James' Hospital, Dublin, Ireland
| | - Sajida Kazi
- Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Paula D James
- Division of Hematology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada; School of Baccalaureate Nursing, St. Lawrence College, Kingston, Ontario, Canada; Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
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4
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Lai SW, Chang CY, Cheng SN, Hu SH, Lai CY, Chen YC. A Comparative Evaluation of an Automated Functional Assay for Von Willebrand Factor Activity in Type 1 Von Willebrand Disease. Int J Gen Med 2021; 14:5167-5174. [PMID: 34511999 PMCID: PMC8421256 DOI: 10.2147/ijgm.s321605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background von Willebrand factor ristocetin cofactor activity (VWF:RCo) is the standard functional assay used for von Willebrand disease (VWD) diagnosis. However, it has some drawbacks including being time consuming and labor intensive and having high inter-laboratory variability. The HemosIL VWF activity assay has the advantages of both high speed and automation. The purpose of this study was to prospectively compare these two functional assays for type 1 VWD detection. Methods Plasma samples from 108 subjects were assessed in this study. HemosIL VWF activity was measured with the HemosIL latex immunoturbidimetric commercial kits by the ACL TOP coagulation analyzer. VWF:RCo was measured by platelet aggregation method. Pearson correlation analyses were performed to estimate the correlation of HemosIL VWF activity with VWF:RCo. Receiver-operator characteristic (ROC) curve analysis was used to evaluate the performance of the two diagnostic tests. Results The correlation coefficient between VWF:RCo and HemosIL VWF activity was 0.874 overall and was 0.761 and 0.811 in the cohorts of type 1 VWD and non-VWD, respectively. The sensitivity and specificity of HemosIL VWF activity assay for type 1 VWD identification were 94.7% and 80.0%, respectively, and the ROC curve of HemosIL VWF activity was larger than that of VWF:RCo (0.928 vs 0.863, p=0.0138). Finally, the positive and negative predictive values of the HemosIL VWF activity assay for type 1 VWD detection were 72.0% and 96.6%, respectively. Conclusion Our results demonstrate that the HemosIL VWF activity assay was an effective method for type 1 VWD screening and diagnosis. It carried good sensitivity and specificity and had a higher ROC curve than VWF:RCo besides showing good correlation with VWF:RCo. With its advantages of greater speed and automated performance, these results suggest that the HemosIL VWF activity assay was reliable and precise in the clinical setting.
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Affiliation(s)
- Shiue-Wei Lai
- Hemophilia Care and Research Center, Tri-Service General Hospital, Taipei, Taiwan.,Division of Hematology/Oncology, Department of Internal Medicine, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Medicine, Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Yau Chang
- School of Medicine, Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Pediatric Hematology/Oncology, Hemophilia Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shin-Nan Cheng
- Hemophilia Care and Research Center, Tri-Service General Hospital, Taipei, Taiwan.,Department of Pediatrics, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.,Department of Pediatrics, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Hsia Hu
- Hemophilia Care and Research Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Chung-Yu Lai
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei City, 114, Taiwan
| | - Yeu-Chin Chen
- Hemophilia Care and Research Center, Tri-Service General Hospital, Taipei, Taiwan.,Division of Hematology/Oncology, Department of Internal Medicine, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan
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5
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Schmidt J, Kruppa P, Georgiou I, Ghods M. Management of large volume liposuction in lipedema patients with von Willebrand disease: A systematic review and treatment algorithm. Clin Hemorheol Microcirc 2021; 78:311-324. [PMID: 33814418 DOI: 10.3233/ch-201063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND When performing large volume liposuction, perioperative management of lipedema patients with coagulation disorders remains challenging due to a lack of clinical experience. With a prevalence of 1% of von Willebrand disease (VWD) in the general population, basic knowledge on diagnostic and adapted surgical strategies are essential for patients' safety. OBJECTIVE Based on a selective literature review, the purpose of this article is to present a standardized algorithm for diagnosis and perioperative treatment of VWD patients undergoing large volume liposuction. METHODS The databases MEDLINE (via PubMed) and Web of Science were selectively searched with the term "(((liposuction) OR (surgery)) OR (lipectomy)) AND (((VWD) OR (hemostaseology)) OR (von Willebrand disease))". Included were articles published in English or German until November 2020. RESULTS The evidence for large volume liposuctions in patients with VWD is limited. Experience is largely based on operations with similar bleeding risks. A safe performance requires an adjustment of the surgical technique and a customized perioperative drug substitution plan. According to the current literature, perioperative thromboembolic events appear to be rare with adequate drug treatment. CONCLUSION The implementation of the developed diagnostic and treatment algorithm may help further reducing bleeding complications and improve the safety for treated patients.
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Affiliation(s)
- Jeremias Schmidt
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/ Hand surgery, Hospital Ernst von Bergmann Clinic Potsdam, Berlin, Germany
| | - Philipp Kruppa
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/ Hand surgery, Hospital Ernst von Bergmann Clinic Potsdam, Berlin, Germany
| | - Iakovos Georgiou
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/ Hand surgery, Hospital Ernst von Bergmann Clinic Potsdam, Berlin, Germany
| | - Mojtaba Ghods
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/ Hand surgery, Hospital Ernst von Bergmann Clinic Potsdam, Berlin, Germany
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Berger J, Schwartz J, Ramachandran S, Leff JD. Review of von Willebrand Disease and Acquired von Willebrand Syndrome for Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 33:3446-3457. [PMID: 31570241 DOI: 10.1053/j.jvca.2019.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/10/2019] [Accepted: 08/17/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Jay Berger
- Department of Anesthesiology, Montefiore Hospital and Medical Center, Bronx, NY.
| | - Joseph Schwartz
- Department of Anesthesiology, Montefiore Hospital and Medical Center, Bronx, NY
| | | | - Jonathan D Leff
- Department of Anesthesiology, Montefiore Hospital and Medical Center, Bronx, NY
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8
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Crespi JA, Barrientos LS, Giovambattista G. von Willebrand disease type 1 in Doberman Pinscher dogs: genotyping and prevalence of the mutation in the Buenos Aires region, Argentina. J Vet Diagn Invest 2017; 30:310-314. [PMID: 29271313 DOI: 10.1177/1040638717750429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
von Willebrand disease (vWD) is the most common inherited coagulopathy in dogs, particularly in Doberman Pinschers. We developed a pyrosequencing-based assay to estimate the frequency of the c.7437G>A mutation associated with vWD type 1 in the Doberman Pinscher population of Buenos Aires, Argentina. We found a 0.41 frequency for the mutated allele, which varied significantly within families (family 1 = 0.43, family 2 = 0.58, unrelated animals = 0.35). The use of a popular founder male carrier of mutant allele A increased vWD incidence within a family and in the general population. The mode of inheritance was confirmed as autosomal dominant with incomplete penetrance. No differences were found between sexes and coat colors. Pyrosequencing was a good complement to clinical and coagulation tests for vWD type 1 diagnosis and a useful alternative for detecting the c.7437G>A mutation.
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Affiliation(s)
- Julian A Crespi
- Instituto de Genética Veterinaria, Facultad de Ciencias Veterinarias, La Plata, Buenos Aires, Argentina
| | - Laura S Barrientos
- Instituto de Genética Veterinaria, Facultad de Ciencias Veterinarias, La Plata, Buenos Aires, Argentina
| | - Guillermo Giovambattista
- Instituto de Genética Veterinaria, Facultad de Ciencias Veterinarias, La Plata, Buenos Aires, Argentina
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9
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Franchini M, Mannucci PM. Gastrointestinal angiodysplasia and bleeding in von Willebrand disease. Thromb Haemost 2017; 112:427-31. [DOI: 10.1160/th13-11-0952] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 04/08/2014] [Indexed: 12/24/2022]
Abstract
SummaryVon Willebrand disease (VWD), the most common genetic bleeding disorder, is characterised by a quantitative or qualitative defect of von Willebrand factor (VWF). Patients with VWD suffer from mucocutaneous bleeding, of severity usually proportional to the degree of VWF defect. In particular, gastrointestinal bleeding associated with angiodysplasia is often a severe symptom of difficult management. This review focuses on the pathophysiology, diagnosis and treatment of VWD-associated gastrointestinal angiodysplasia and related bleeding.
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10
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Keeshen TP, Case JB, Runge JJ, Singh A, Mayhew PD, Steffey MA, Culp WTN. Outcome of laparoscopic ovariohysterectomy or ovariectomy in dogs with von Willebrand disease or factor VII deficiency: 20 cases (2012–2014). J Am Vet Med Assoc 2017; 251:1053-1058. [DOI: 10.2460/javma.251.9.1053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Efficacy of Octocog Alfa (Advate) in a Child with Type 3 von Willebrand Disease and Alloantibodies. J Clin Med 2017; 6:jcm6090085. [PMID: 28926986 PMCID: PMC5615278 DOI: 10.3390/jcm6090085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 09/04/2017] [Accepted: 09/12/2017] [Indexed: 11/17/2022] Open
Abstract
Von Willebrand disease (VWD) is the most frequent inherited bleeding disorder and is caused by either a quantitative and/or qualitative defect of the multimeric glycoprotein vonWillebrand factor (VWF).[...].
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12
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Federici AB. Current and emerging approaches for assessing von Willebrand disease in 2016. Int J Lab Hematol 2017; 38 Suppl 1:41-9. [PMID: 27426859 DOI: 10.1111/ijlh.12540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/07/2016] [Indexed: 12/13/2022]
Abstract
UNLABELLED von Willebrand disease (VWD) is the most common inherited bleeding disorder and is due to a deficiency and/or abnormality of von Willebrand factor (VWF). VWD is inherited in an autosomal dominant or recessive pattern, but women are apparently more symptomatic. Diagnosis of VWD is still difficult in most countries due to the multiple activities of VWF and the heterogeneity of the disease. VWD is mainly associated with mild mucosal bleeding although gastrointestinal and joint bleeds may occur in severe VWD forms. This review describes the most recent clinical and laboratory procedures for the correct diagnosis of VWD. Assays for the evaluation of the platelet-dependent VWF activity (PD-VWFact) with or without ristocetin as well as VWF collagen binding (VWF:CB) are currently in use. However, other tests such as VWF antigen (VWF:Ag), factor VIII procoagulant ( FVIII C), ristocetin-induced platelet agglutination (RIPA), multimeric analysis (VWF:MA), VWF propeptide (VWFpp), VWF:FVIII binding assay (VWF:FVIIIB), and the assessment of biological response to desmopressin (DDAVP) are necessary to characterize VWD types. Levels of VWF activities <30 U/dL have been associated with a bleeding phenotype and the presence of mutations in the VWF gene.
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Affiliation(s)
- A B Federici
- Hematology and Transfusion Medicine, Department of Oncology and Onco-Hematology, L. Sacco University Hospital, University of Milan, Milan, Italy
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13
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Kauskot A, Poirault-Chassac S, Adam F, Muczynski V, Aymé G, Casari C, Bordet JC, Soukaseum C, Rothschild C, Proulle V, Pietrzyk-Nivau A, Berrou E, Christophe OD, Rosa JP, Lenting PJ, Bryckaert M, Denis CV, Baruch D. LIM kinase/cofilin dysregulation promotes macrothrombocytopenia in severe von Willebrand disease-type 2B. JCI Insight 2016; 1:e88643. [PMID: 27734030 DOI: 10.1172/jci.insight.88643] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
von Willebrand disease type 2B (VWD-type 2B) is characterized by gain-of-function mutations of von Willebrand factor (vWF) that enhance its binding to platelet glycoprotein Ibα and alter the protein's multimeric structure. Patients with VWD-type 2B display variable extents of bleeding associated with macrothrombocytopenia and sometimes with thrombopathy. Here, we addressed the molecular mechanism underlying the severe macrothrombocytopenia both in a knockin murine model for VWD-type 2B by introducing the p.V1316M mutation in the murine Vwf gene and in a patient bearing this mutation. We provide evidence of a profound defect in megakaryocyte (MK) function since: (a) the extent of proplatelet formation was drastically decreased in 2B MKs, with thick proplatelet extensions and large swellings; and (b) 2B MKs presented actin disorganization that was controlled by upregulation of the RhoA/LIM kinase (LIMK)/cofilin pathway. In vitro and in vivo inhibition of the LIMK/cofilin signaling pathway rescued actin turnover and restored normal proplatelet formation, platelet count, and platelet size. These data indicate, to our knowledge for the first time, that the severe macrothrombocytopenia in VWD-type 2B p.V1316M is due to an MK dysfunction that originates from a constitutive activation of the RhoA/LIMK/cofilin pathway and actin disorganization. This suggests a potentially new function of vWF during platelet formation that involves regulation of actin dynamics.
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Affiliation(s)
- Alexandre Kauskot
- INSERM UMR-S 1176, Univ Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France.,INSERM UMR-S 1140, Univ Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - Frédéric Adam
- INSERM UMR-S 1176, Univ Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Vincent Muczynski
- INSERM UMR-S 1176, Univ Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Gabriel Aymé
- INSERM UMR-S 1176, Univ Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Caterina Casari
- INSERM UMR-S 1176, Univ Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Jean-Claude Bordet
- Laboratoire d'Hémostase, Hôpital Edouard Herriot, Lyon, France.,Laboratoire de Recherche sur l'Hémophilie, UCBL1, Faculté de Médecine Lyon-Est, Lyon, France
| | - Christelle Soukaseum
- INSERM UMR-S 1176, Univ Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | | | - Valérie Proulle
- INSERM UMR-S 1176, Univ Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France.,Department of Biological Hematology, CHU Bicêtre, Hôpitaux Universitaires Paris Sud, AP-HP, Paris, France
| | | | - Eliane Berrou
- INSERM UMR-S 1176, Univ Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Olivier D Christophe
- INSERM UMR-S 1176, Univ Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Jean-Philippe Rosa
- INSERM UMR-S 1176, Univ Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Peter J Lenting
- INSERM UMR-S 1176, Univ Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Marijke Bryckaert
- INSERM UMR-S 1176, Univ Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Cécile V Denis
- INSERM UMR-S 1176, Univ Paris-Sud, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Dominique Baruch
- INSERM UMR-S 1140, Univ Paris Descartes, Sorbonne Paris Cité, Paris, France
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Eghbali A, Melikof L, Taherahmadi H, Bagheri B. Efficacy of tranexamic acid for the prevention of bleeding in patients with von Willebrand disease and Glanzmann thrombasthenia: a controlled, before and after trial. Haemophilia 2016; 22:e423-6. [PMID: 27478149 DOI: 10.1111/hae.13051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Reducing bleeding episodes is very important in haematology disorders like von Willebrand disease (VWD) and Glanzmann thrombasthenia (GT). Replacement factors are very expensive although prophylactic drugs are affordable. OBJECTIVE To study the prophylactic effects of tranexamic acid (TXA) for reduction of bleeding episodes in patients with VWD and GT in non-invasive conditions. METHODS A controlled, double-blind before and after single-centre trial was performed in Amir-Kabir Hospital (Arak, Iran). The study was done on 17 patients with VWD and three patients with GT with minimum age of 2 years. Patients were received placebo for 6 months to evaluate the frequency and severity of bleeding and also to record the frequency of use of factor concentrates and platelet transfusion. After that, patients were given oral single dose of TXA 25 mg kg(-1) day(-1) for 6 months. The mentioned outcomes were studied and compared between two phases of study. Safety assessment was done in all patients. RESULTS Tranexamic acid caused a significant reduction in number of Grade 1 and Grade 2 bleeding episodes in VWD patients (P < 0.001 and P < 0.01 respectively). In addition, TXA therapy was associated with significant decrease in the use of factor concentrates (P < 0.05). Number of bleeding episodes decreased in GT patients who used TXA; however, difference between two phases of studies was not significant (P = 0.1). TXA had no effect in the frequency of platelet transfusions in GT patients. TXA therapy was associated with headache, back pain and musculoskeletal pain. No case of allergy or thromboembolic events was seen following treatment. CONCLUSIONS The results suggest that TXA is safe and effective to reduce bleeding and use of factor concentrates in VWD patients. In addition, TXA therapy can decrease bleeding in GT patients.
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Affiliation(s)
- A Eghbali
- Department of Pediatric Hematology and Oncology, Arak University of Medical Sciences, Arak, Iran
| | - L Melikof
- Department of Pediatric Hematology and Oncology, Arak University of Medical Sciences, Arak, Iran
| | - H Taherahmadi
- Department of Pediatric Hematology and Oncology, Arak University of Medical Sciences, Arak, Iran
| | - B Bagheri
- Cancer Research Center and Department of Pharmacology, Semnan University of Medical Sciences, Semnan, Iran.
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15
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Boender J, Kruip MJHA, Leebeek FWG. A diagnostic approach to mild bleeding disorders. J Thromb Haemost 2016; 14:1507-16. [PMID: 27208505 DOI: 10.1111/jth.13368] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Indexed: 01/02/2023]
Abstract
Mild inherited bleeding disorders are relatively common in the general population. Despite recent advances in diagnostic approaches, mild inherited bleeding disorders still pose a significant diagnostic challenge. Hemorrhagic diathesis can be caused by disorders in primary hemostasis (von Willebrand disease, inherited platelet function disorders), secondary hemostasis (hemophilia A and B, other (rare) coagulant factor deficiencies) and fibrinolysis, and in connective tissue or vascular formation. This review summarizes the currently available diagnostic methods for mild bleeding disorders and their pitfalls, from structured patient history to highly specialized laboratory diagnosis. A comprehensive framework for a diagnostic approach to mild inherited bleeding disorders is proposed.
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Affiliation(s)
- J Boender
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M J H A Kruip
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - F W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
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16
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Franchini M, Mannucci PM. Von Willebrand factor (Vonvendi®): the first recombinant product licensed for the treatment of von Willebrand disease. Expert Rev Hematol 2016; 9:825-30. [DOI: 10.1080/17474086.2016.1214070] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Rugeri L, Ashrani AA, Nichols WL, Trousdale RT, Pruthi RK. A single-centre study of haemostatic outcomes of joint replacement in von Willebrand disease and control patients and an analysis of the literature. Haemophilia 2016; 22:934-942. [PMID: 27385645 DOI: 10.1111/hae.13027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Haemostatic assessments of patients with von Willebrand disease (VWD) who undergo total knee arthroplasty (TKA) and total hip arthroplasty (THA) have mainly relied on subjective parameters. AIMS To compare objective haemostatic outcomes of TKA/THA in VWD patients and controls without bleeding disorders. METHODS We retrospectively analysed haemostatic outcomes in VWD patients undergoing TKA/THA from 1993 to 2011 and compared them with two matched controls per operation. Using one-way analysis of variance, we tested the effect of VWD on bleeding risk after TKA and THA. RESULTS Twelve VWD patients (6 type 1, 3 type 2M, 1 each of types 2A/2B/3) undergoing 19 operations (12 TKA, 7 THA) were matched to 38 controls. One (5%) of 19 operations in VWD patients and none of the control operations met clinical criteria for major bleeding. Baseline and postoperative day 1 haemoglobin levels, postoperative blood loss, transfused red blood cells (RBCs) and mean hospitalization days were not significantly different. More VWD patients than controls received RBC transfusions [12 (63%) vs. 12 (32%)]. Only 9 (47%) VWD patients vs. 38 (100%) controls received pharmacologic VTE prophylaxis. No postoperative symptomatic VTE occurred in either group. CONCLUSION In this largest, single-institutional study, von Willebrand factor replacement based on daily levels resulted in low frequency of major bleeding in VWD patients after TKA/THA. RBC transfusion was more frequent compared with matched controls, but other objective measures of haemostasis were similar. Lack of sufficient details in published reports precluded comparison of haemostatic outcomes.
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Affiliation(s)
- L Rugeri
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - A A Ashrani
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - W L Nichols
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - R T Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - R K Pruthi
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, MN, USA
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18
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Livesey K, Yealy DM, Li J, Moore CG, Ragni MV. Von Willebrand disease in the emergency department. Haemophilia 2015; 22:263-267. [DOI: 10.1111/hae.12841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 12/20/2022]
Affiliation(s)
- K. Livesey
- Division Hematology/Oncology; Department of Medicine; University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - D. M. Yealy
- Department of Emergency Medicine; University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - J. Li
- Department of Healthy Policy and Management; Graduate School of Public Health Pittsburgh; Pittsburgh PA USA
| | - C. G. Moore
- Department of Biostatistics; Carolinas Healthcare System; Charlotte NC USA
| | - M. V. Ragni
- Division Hematology/Oncology; Department of Medicine; University of Pittsburgh Medical Center; Pittsburgh PA USA
- Hemophilia Center of Western PA; Pittsburgh PA USA
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19
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Stufano F, Baronciani L, Pagliari MT, Franchi F, Cozzi G, Garcia-Oya I, Bucciarelli P, Boscarino M, Peyvandi F. Evaluation of an heterogeneous group of patients with von Willebrand disease using an assay alternative to ristocetin induced platelet agglutination. J Thromb Haemost 2015; 13:1806-14. [PMID: 26206100 DOI: 10.1111/jth.13062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 07/10/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diagnosis of von Willebrand disease (VWD) type 2 usually relies on the discrepancy between the von Willebrand factor (VWF) ristocetin cofactor activity (VWF:RCo) and VWF antigen (VWF:Ag). Type 2B patients can be discriminated from other qualitative VWD variants by using ristocetin-induced platelet agglutination (RIPA) test. The major limitation of RIPA is the requirement of fresh blood sample. OBJECTIVES In this study, we evaluated the VWF gain-of-function mutant GPIb binding (VWF:GPIbM) and VWF:RCo assays to investigate whether the VWF:GPIbM/VWF:RCo ratio was able to identify the type 2B variant among an heterogeneous VWD population, previously characterized following the ISTH-SSC guidelines. PATIENTS/METHODS Seventy-six VWD patients and 31 healthy subjects were evaluated by using VWF:Ag, VWF:RCo, and VWF:GPIbM assays. RESULTS The mean (minimum-maximum values) VWF:GPIbM/VWF:RCo ratio was higher in type 2B patients (2.53, 0.84-6.11) than in healthy controls (1.05, 0.87-1.34), type 1 (0.85, 0.51-1.15), 2A (1.20, 0.36-2.82), and 2M (1.07, 0.91-1.38) (P < 0.0001). Type 2B variants were divided into four groups (A, B, C, and D) according to their different multimeric patterns. The mean value of the VWF:GPIbM/VWF:RCo ratio in the four groups showed an increasing trend from group A (1.08) to D (3.69), proportional to the loss of high molecular weight multimers. Among 32 type 2B patients, previously diagnosed with RIPA, 8 (mainly with a type I New York/Malmö phenotype) were not confirmed using the VWF:GPIbM/VWF:RCo ratio. CONCLUSIONS Whenever the RIPA test is not feasible, the VWF:GPIbM/VWF:RCo ratio might help to identify severe type 2B VWD patients.
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Affiliation(s)
- F Stufano
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy
| | - L Baronciani
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy
| | - M T Pagliari
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy
| | - F Franchi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - G Cozzi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy
| | - I Garcia-Oya
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy
| | - P Bucciarelli
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy
| | - M Boscarino
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy
| | - F Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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20
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Utility of a high VWF: FVIII ratio in preventing FVIII accumulation: a study in VWF-deficient mice. Blood Coagul Fibrinolysis 2015; 26:515-21. [PMID: 25767894 PMCID: PMC4500654 DOI: 10.1097/mbc.0000000000000269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Treatment of von Willebrand disease typically requires multiple infusions of von Willebrand factor (VWF)/factor VIII (FVIII) concentrate. Accumulation of FVIII is a clinical concern due to potential risk for thromboembolism. This study sought to determine whether VWF/FVIII concentrate of high VWF:FVIII ratio can prevent FVIII accumulation. VWF-deficient knockout mice received four 150 IU/kg VWF:ristocetin cofactor (RCo) infusions at 3-h intervals, with VWF/FVIII concentrates of a high (Haemate P/Humate-P) or low (Wilate) VWF:FVIII ratio. After each infusion, trough FVIII and VWF levels in plasma were determined. Separately, pharmacokinetic analysis was performed after single 250-IU/kg VWF:RCo infusions of each concentrate. Over the course of the four infusions, trough FVIII increased significantly in the group receiving Wilate (P < 0.001), but not Haemate P/Humate P (P = 0.058). After the first infusion, mean trough FVIII level in the Wilate group (31.7 IU/dl) was greater by 82% (P = 0.017) than that in the Haemate P/Humate P group (17.4 IU/dl). After the final infusion, mean trough FVIII of animals receiving Wilate (55.1 IU/dl) continued to exceed that of Haemate P/Humate P recipients (30.2 IU/dl) significantly (P < 0.001). Trough VWF levels were similar in the two groups. The VWF pharmacokinetics of the two concentrates coincided closely; however, the FVIII peak concentration and area under the curve were approximately twice as great in the mice treated with Wilate. In a murine model of severe von Willebrand disease, a VWF/FVIII concentrate with a high VWF:FVIII ratio prevented persistent exposure to elevated trough FVIII levels.
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21
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Schinco P, Cultrera D, Valeri F, Borchiellini A, Mantuano M, Gorla F, Savarese A, Teruzzi C. Cost-consequence analysis of long-term prophylaxis in the treatment of von Willebrand disease in the Italian context. CLINICOECONOMICS AND OUTCOMES RESEARCH 2014; 7:17-25. [PMID: 25565871 PMCID: PMC4274135 DOI: 10.2147/ceor.s71892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Prophylaxis with von Willebrand factor (VWF)/factor VIII (FVIII) concentrates is a potential approach for patients with severe von Willebrand disease (VWD). As far as we are aware, to date there have been no pharmacoeconomic analyses in order to assess the economic impact of treatments for severe VWD. The analysis presented here estimates the cost–benefit ratio of VWF with a low FVIII content when compared with VWF/FVIII concentrates currently used in Italy for long-term prophylaxis in patients with severe VWD. Methods A cost–consequence analysis was undertaken to assess the economic impact of the treatment of severe VWD from the perspective both of the Italian National Health Service and society. The analysis was based on four case reports of long-term prophylaxis with VWD with VWF/FVIII concentrates and VWF with a low FVIII content. The costs per patient included direct and indirect costs for each treatment. Results Considering the four case reports, health care costs (without cost of treatment) and indirect costs per patient per year were lower with VWF with a low FVIII content than VWF/FVIII concentrates. The total health care costs (without cost of treatment) and indirect costs avoided with VWF with a low FVIII content per patient per year ranged from €2,295 to €17,530 and from €1,867 to €4,978, respectively. Conclusion VWF with a low FVIII content seems to be a cost-effective treatment option for patients with severe VWD. Although the drug cost per se is higher, the use of VWF with a low FVIII content is associated with decreased consumption of hospital resources and fewer lost working days due to bleedings and consequently with an improvement of the quality of life of the patients.
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Affiliation(s)
- Piercarla Schinco
- Hemostasis and Thrombosis Unit, Molinette Hospital of Turin, Milan, Italy
| | - Dorina Cultrera
- Department of Hematology, Hemophilia Regional Reference Center, University Hospital of Catania, Milan, Italy
| | - Federica Valeri
- Hemostasis and Thrombosis Unit, Molinette Hospital of Turin, Milan, Italy
| | | | - Michela Mantuano
- HEMAR-Health Economics, Market Access and Reimbursement, Temas-A Quintiles Company, Milan, Italy
| | - Francesca Gorla
- HEMAR-Health Economics, Market Access and Reimbursement, Temas-A Quintiles Company, Milan, Italy
| | - Alessia Savarese
- HEMAR-Health Economics, Market Access and Reimbursement, Temas-A Quintiles Company, Milan, Italy
| | - Cristina Teruzzi
- HEMAR-Health Economics, Market Access and Reimbursement, Temas-A Quintiles Company, Milan, Italy
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22
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Abstract
Abstract
VWD is the most common inherited bleeding disorder and is due to a deficiency and/or abnormality of VWF. VWD is inherited in an autosomal-dominant or autosomal-recessive pattern, but women are apparently more symptomatic. Three main criteria are required for correct diagnoses of VWD: (1) positive bleeding history since childhood, (2) reduced VWF activity in plasma, and (3) history of bleeding in the family. The bleeding score, together with baseline VWF levels and family history, have been proposed as more evidence-based criteria for VWD. Measurements of a reduced VWF activity in plasma are essential for the diagnosis of VWD; assays for the evaluation of the interactions between VWF and platelet glycoprotein Ib receptor with or without ristocetin, as well as VWF collagen binding, are currently in use. However, other tests such as VWF antigen, factor VIII, ristocetin-induced platelet agglutination, multimeric analysis, VWF propeptide, VWF/FVIII binding assay, and assessment of biological response to desmopressin are necessary to characterize VWD types. Levels of VWF activities <30 U/dL have been associated with a bleeding phenotype and the presence of mutations in the VWF gene.
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23
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The bleeding score predicts clinical outcomes and replacement therapy in adults with von Willebrand disease. Blood 2014; 123:4037-44. [PMID: 24786773 DOI: 10.1182/blood-2014-02-557264] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Analyses of the bleeding tendency by means of the bleeding score (BS) have been proposed until now to confirm diagnosis but not to predict clinical outcomes in patients with inherited von Willebrand disease (VWD). We prospectively followed up, for 1 year, 796 Italian patients with different types of VWD to determine whether the previous BS of European VWD1 is useful to predict the occurrence of spontaneous bleeds severe enough to require replacement therapy with desmopressin (DDAVP) and/or von Willebrand factor (VWF)/factor VIII concentrates. Among the 796 patients included, 75 (9.4%) needed treatment of 232 spontaneous bleeding events. BS >10 and VWF:ristocetin cofactor activity <10 U/dL were associated with the risk of bleeding, but only a BS >10 remained highly associated in a multivariable Cox proportional hazard model (adjusted hazard ratio: 7.27 [95% confidence interval, 3.83-13.83]). Although the bleeding event-free survival was different in VWD types, only a BS >10 could predict for each type which patient had bleeding events severe enough to require treatment with DDAVP and/or concentrates. Therefore, BS can be considered a simple predictor of clinical outcomes of VWD and may identify patients needing intensive therapeutic regimens.
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24
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Mikhail S, Aldin ES, Streiff M, Zeidan A. An update on type 2B von Willebrand disease. Expert Rev Hematol 2014; 7:217-31. [PMID: 24521271 DOI: 10.1586/17474086.2014.868771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Type 2B von Willebrand disease (VWD) accounts for fewer than 5% of all VWD patients. In this disease, mutations in the A1 domain result in increased von Willebrand factor (VWF) binding to platelet GPIbα receptors, causing increased platelet clearance and preferential loss of high molecular weight VWF multimers. Diagnosis is complicated because of significant clinical variations even among patients with identical mutations. Platelet transfusion often provides suboptimal results since transfused platelets may be aggregated by the patients' abnormal VWF. Desmopressin may cause a transient decrease in platelet count that could lead to an increased risk of bleeding. Replacement therapy with factor VIII/VWF concentrates is the most effective approach to prevention and treatment of bleeding in type 2B VWD.
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Affiliation(s)
- Sameh Mikhail
- Department of Hematology, Ohio State University Medical Center, Columbus, OH, USA
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25
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Franchini M, Lippi G. Pharmacotherapy of von Willebrand disease. Expert Opin Orphan Drugs 2013. [DOI: 10.1517/21678707.2013.801315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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26
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Lawrie AS, Stufano F, Canciani MT, Mackie IJ, Machin SJ, Peyvandi F. A comparative evaluation of a new automated assay for von Willebrand factor activity. Haemophilia 2013; 19:338-42. [PMID: 23205618 DOI: 10.1111/hae.12064] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2012] [Indexed: 12/01/2022]
Abstract
The ristocetin cofactor assay (VWF:RCo) is the reference method for assessing von Willebrand factor (VWF) activity in the diagnosis of von Willebrand's Disease (VWD). However, the assay suffers from poor reproducibility and sensitivity at low levels of VWF and is labour intensive. We have undertaken an evaluation of a new immunoturbidimetric VWF activity (VWF:Ac) assay (INNOVANCE(®) VWF Ac. Siemens Healthcare Diagnostics, Marburg, Germany) relative to an established platelet-based VWF:RCo method. Samples from 50 healthy normal subjects, 80 patients with VWD and 50 samples that exhibited 'HIL' (i.e. Haemolysis, Icterus or Lipaemia) were studied. VWF:Ac, VWF:RCo and VWF:Ag were performed on a CS-analyser (Sysmex UK Ltd, Milton Keynes, UK), all reagents were from Siemens Healthcare Diagnostics. The VWF:Ac assay, gave low intra- and inter-assay imprecision (over a 31-day period, n = 200 replicate readings) using commercial normal (Mean 96.2 IU dL(-1), CV < 3.0%) and pathological (Mean 36.1 IU dL(-1), CV < 3.5%) control plasmas. The normal and clinical samples exhibited good correlation between VWF:RCo (range 3-753 IU dL(-1)) and VWF:Ac (rs = 0.97, P < 0.0001), with a mean bias of 5.6 IU dL(-1). Ratios of VWF:Ac and VWF:RCo to VWF:Ag in the VWD samples were comparable, although VWF:Ac had a superior lower level of detection to that of VWF:RCo (3% and 5% respectively). A subset (n = 97) of VWD and HIL samples were analysed for VWF:Ac at two different dilutions to assess the effect on relative potency, no significant difference was observed (P = 0.111). The INNOVANCE(®) VWF Ac assay was shown to be reliable and precise.
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Affiliation(s)
- A S Lawrie
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK.
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27
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Lagarrigue J, Richez B, Julliac B, Saltel L, Nurden P, Sztark F. [Epidural labor analgesia and parturient with type 2B von Willebrand disease]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2013; 32:56-59. [PMID: 23218955 DOI: 10.1016/j.annfar.2012.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 10/25/2012] [Indexed: 06/01/2023]
Abstract
Type 2B von Willebrand disease (vWD) is an inherited bleeding syndrome resulting from a qualitative abnormality of von Willebrand Factor with an increased affinity for the glycoprotein Ib platelet receptor. Pregnancy increases the severity of this disease by decreasing the platelet count restricting epidural anaesthesia because of adverse risk of spinal bleeding. There is a phenotypic variability of Type 2B vWD depending of the von Willebrand Factor mutation. We report here the strategy we used to administer epidural anaesthesia for a patient with Type 2B vWD resulting from the P1337L mutation of von Willebrand Factor.
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Affiliation(s)
- J Lagarrigue
- Service d'anesthésie-réanimation I, hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France
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28
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Mattoso CRS, Takahira RK, Beier SL, Araujo JP, Corrente JE. Evaluation of von Willebrand Factor During Pregnancy, Lactation and Oestrous Cycle in Bitches Affected and Unaffected by von Willebrand Disease. Reprod Domest Anim 2012; 48:416-22. [DOI: 10.1111/rda.12089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 08/25/2012] [Indexed: 11/29/2022]
Affiliation(s)
- CRS Mattoso
- School of Veterinary Medicine and Animal Science; São Paulo State University; Botucatu; São Paulo; Brazil
| | - RK Takahira
- School of Veterinary Medicine and Animal Science; São Paulo State University; Botucatu; São Paulo; Brazil
| | - SL Beier
- School of Veterinary Medicine, Agricultural and Animal Sciences Center; Santa Catarina State University; Lages; Santa Catarina; Brazil
| | - JP Araujo
- Biosciences Institute; São Paulo State University; Botucatu; São Paulo; Brazil
| | - JE Corrente
- Biosciences Institute; São Paulo State University; Botucatu; São Paulo; Brazil
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29
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Bharati KP, Prashanth UR. Von Willebrand disease: an overview. Indian J Pharm Sci 2012; 73:7-16. [PMID: 22131616 PMCID: PMC3224412 DOI: 10.4103/0250-474x.89751] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 01/10/2011] [Accepted: 01/15/2011] [Indexed: 12/05/2022] Open
Abstract
Most commonly inherited bleeding disorder, first described in Aland Islands by Erik von Willebrand. It occurs as a result of decrease in plasma levels or defect in von Willebrand factor which is a large multimeric glycoprotein. Monomers of this glycoprotein undergo N-glycosylation to form dimers which get arranged to give multimers. Binding with plasma proteins (especially factor VIII) is the main function of von Willebrand factor. The disease is of two forms: Inherited and acquired forms. Inherited forms are of three major types. They are type 1, type 2, and type 3; in which type 2 is sub-divided into 2A, 2B, 2M, 2N. Type 1 is more prevalent than all other types. Mucocutaneous bleeding is mild in type 1 whereas it is mild to moderate in types 2A, 2B, and 2M. Type 2N has similar symptoms of haemophilia. The pathophysiology of each type depends on the qualitative or quantitative defects in von Willebrand factor. The diagnosis is based on von Willebrand factor antigen, von Willebrand factor activity assay, FVIII coagulant activity and some other additional tests. Results should be analyzed within the context of blood group. von Willebrand factor multimer analysis is essential for typing and sub typing the disease. The management of the disease involves replacement therapy, non-replacement therapy and other therapies that include antifibrinolytics and topical agents.
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Affiliation(s)
- K Pavani Bharati
- Department of Pharmacy Practice, JNTUK, Vizianagaram - 535 003, India
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30
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Pailhes R, Lafosse JM, Marty P, Dahan O, Voisin S, Sié P. Large psoas haematoma and femoral neuropathy in a patient with type 2B von Willebrand's disease. Haemophilia 2012; 18:e407-8. [PMID: 23005922 DOI: 10.1111/hae.12022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2012] [Indexed: 11/29/2022]
Affiliation(s)
- R Pailhes
- Service de Chirurgie Orthopédique et Traumatologique, CHU de Toulouse, Toulouse, France
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31
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Castaman G, Coppola A, Zanon E, Boeri E, Musso M, Siragusa S, Federici AB, Mancuso G, Barillari G, Biasoli C, Feola G, Franchini M, Moratelli S, Gamba G, Schinco P, Valdrè L, Dragani A, Mazzucconi G, Tagliaferri A, Morfini M. Efficacy and safety during formulation switch of a pasteurized VWF/FVIII concentrate: results from an Italian prospective observational study in patients with von Willebrand disease. Haemophilia 2012; 19:82-8. [DOI: 10.1111/hae.12005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2012] [Indexed: 11/27/2022]
Affiliation(s)
| | - A. Coppola
- Federico II University Hospital; Naples; Italy
| | - E. Zanon
- University Hospital; Padua; Italy
| | | | - M. Musso
- University Hospital Catania; Catania; Italy
| | | | - A. B. Federici
- IRCCS Cà Granda Maggiore Policlinico Hospital Foundation and Department of Internal Medicine; AB Bonomi Hemophilia Thrombosis Center; University of Milan; Milan; Italy
| | | | | | | | - G. Feola
- San Luca Hospital; Vallo della Lucania; Italy
| | | | | | - G. Gamba
- San Matteo Hospital; Pavia; Italy
| | - P. Schinco
- San Giovanni Battista Hospital; Torino; Italy
| | - L. Valdrè
- S. Orsola-Malpighi Hospital; Bologna; Italy
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32
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Bombeccari GP, Guzzi G, Bucciarelli P, Pallotti F, Spadari F. Hematological evaluation of acquired von Willebrand syndrome before oral surgery: Management of an unusual case. Asian J Transfus Sci 2012; 6:46-7. [PMID: 22623844 PMCID: PMC3353631 DOI: 10.4103/0973-6247.95052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Gian P Bombeccari
- Department of Reconstructive and Diagnostic Surgical Sciences, Unit of Oral Pathology and Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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33
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Affiliation(s)
- M Morfini
- Agency for Haemophilia, Department of Emergency & Reception, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
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34
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Zhao Y, Gu Y, Ji S, Yang J, Yu Z, Ruan C. Development of an ELISA method for testing VWF ristocetin cofactor activity with improved sensitivity and reliability in the diagnosis of von Willebrand disease. Eur J Haematol 2012; 88:439-45. [DOI: 10.1111/j.1600-0609.2012.01760.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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35
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36
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Federici AB, James P. Current management of patients with severe von Willebrand disease type 3: a 2012 update. Acta Haematol 2012; 128:88-99. [PMID: 22722677 DOI: 10.1159/000338208] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 03/05/2012] [Indexed: 11/19/2022]
Abstract
Von Willebrand disease type 3 (VWD3) is the most severe form of this bleeding disorder due to the almost complete deficiency of von Willebrand factor (VWF). VWD3 is inherited as an autosomal recessive trait. While heterozygous carriers exhibit mild or no bleeding symptoms, most patients with VWD3, which is characterized by undetectable levels of VWF antigen (VWF:Ag) and reduced concentrations (<20 IU/dl) of factor VIII (FVIII), show severe bleeding symptoms. Although the incidence of VWD3 is rare, the condition is of considerable interest because of its severe clinical presentation, the need for replacement therapy and the risk of alloantibodies following infusion of plasma-derived VWF concentrates. This review, based on clinical experience, provides an update on the clinical, laboratory and molecular markers of VWD3 that can be useful for determining the optimal therapeutic approach in these patients.
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Affiliation(s)
- Augusto B Federici
- Hematology and Transfusion Medicine, L. SACCO University Hospital and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
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Raquet E, Stockschläder M, Dickneite G. Repeated infusions of VWF/FVIII concentrate: impact of VWF:FVIII ratio on FVIII trough and peak levels in a rabbit model. Haemophilia 2011; 17:808-14. [PMID: 21726357 DOI: 10.1111/j.1365-2516.2011.02603.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The ratio of von Willebrand factor (VWF) to FVIII differs among available VWF/FVIII concentrates. Repeated infusions of concentrates with a low VWF:FVIII ratio may expose patients with von Willebrand disease to supranormal FVIII levels. The aim of this study was to determine the effects of repeated infusions with two VWF/FVIII concentrates differing in VWF:FVIII ratio on attained FVIII trough and peak levels as well as other pharmacokinetic parameters. Rabbits were randomized to receive multiple 150 IU kg⁻¹ VWF:RCo infusions at 4 h intervals with VWF/FVIII concentrates of a high (Haemate® P/Humate-P®) or low (Wilate®) VWF:FVIII ratio. Trough plasma FVIII and VWF levels were measured after each infusion. Pharmacokinetic analysis was performed using samples collected frequently after infusion. Mean FVIII trough level after the first Wilate infusion was 50.6 IU dL⁻¹ with a 95% confidence interval (CI) of 43.1-58.2 IU dL⁻¹, compared with 31.8 IU dL⁻¹ (CI, 24.4-39.1 IU dL⁻¹) for Haemate P (P<0.001). Trough levels progressively increased over the 24 h treatment period in both groups. After the final infusion, mean trough FVIII remained significantly higher (P = 0.002) in recipients of Wilate. Mean peak FVIII concentration after infusion was 67% higher in the Wilate group (167 vs. 100 IU dL⁻¹ , respectively; P = 0.002). Mean cumulative exposure to FVIII, as measured by area under the curve, was 84% greater in Wilate-treated animals. Half-life did not differ between the two concentrates. Animal model data suggest that exposure to elevated FVIII levels can be reduced through use of VWF/FVIII concentrates with higher VWF:FVIII ratios.
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Affiliation(s)
- E Raquet
- Departments of Preclinical Research and Development Medical Affairs, Commercial Development Coagulation, CSL Behring GmbH, Marburg, Germany
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JAMES AH. Diagnosis and management of women with bleeding disorders - international guidelines and consensus from an international expert panel. Haemophilia 2011; 17 Suppl 1:3-5. [DOI: 10.1111/j.1365-2516.2011.02557.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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von Willebrand disease: a clinical and laboratory study of sixty-five patients. Ann Hematol 2011; 90:1183-90. [DOI: 10.1007/s00277-011-1266-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 05/24/2011] [Indexed: 10/18/2022]
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Miesbach W, Berntorp E. When von Willebrand disease comes into age - a matter of change? Eur J Haematol 2011; 86:496-501. [DOI: 10.1111/j.1600-0609.2011.01611.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tuohy E, Litt E, Alikhan R. Treatment of patients with von Willebrand disease. J Blood Med 2011; 2:49-57. [PMID: 22287863 PMCID: PMC3262353 DOI: 10.2147/jbm.s9890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Indexed: 11/23/2022] Open
Abstract
Von Willebrand disease (vWD) is the most common hereditary bleeding disorder. The aim of therapy is to correct the dual hemostatic defect, due to defective platelet adhesion-aggregation and abnormal coagulation due to Factor VIII (FVIII) deficiency. The choice of treatment depends on a number of factors, including the severity of the bleed, the procedure planned, the subtype and severity of the disease and the age and morbidity of the patient. Desmopressin (DDAVP) is the treatment of choice for type 1 vWD as it increases endogenous release of FVIII and von Willebrand factor (vWF) and is also used in some subtypes of type 2 vWD. In those patients in whom DDAVP is ineffective or contraindicated, levels can be restored by infusing vWF:FVIII concentrates. The role of antifibrinolytic treatment is an important adjunct to replacement therapy during minor or major surgery involving mucosal surfaces. The dosing and timing of vWF:FVIII concentrates is important depending on the nature of the surgical procedure. The role of secondary prophylaxis needs to be further defined.
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Affiliation(s)
- Emma Tuohy
- Department of Haematology, University Hospital of Wales, Cardiff, UK
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Pecori Giraldi F, Ambrogio AG, Fatti LM, Rubini V, Cozzi G, Scacchi M, Federici AB, Cavagnini F. Von Willebrand factor and fibrinolytic parameters during the desmopressin test in patients with Cushing's disease. Br J Clin Pharmacol 2011; 71:132-6. [PMID: 21143510 DOI: 10.1111/j.1365-2125.2010.03812.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Desmopressin is a known haemostatic agent and is also being used, albeit at lower doses, during the diagnostic work-up of Cushing's syndrome, a condition characterized by excess cortisol concentrations and frequent thromboembolic events. No study has yet evaluated whether administration of desmopressin for diagnostic purposes induces significant, adverse changes in endothelial cell markers in these patients. WHAT THIS STUDY ADDS Administration of desmopressin to patients with Cushing's disease induces changes in endothelial cell markers comparable with those observed in obese and normal weight subjects. It follows, that desmopressin testing does not induce disease-specific untoward changes in coagulatory markers in patients with endogenous hypercortisolism and its use in this context appears safe. AIMS Desmopressin, a vasopressin analogue, is used for various clinical purposes, including haemostasis and, in recent times, the diagnostic work-up of patients with Cushing's syndrome, a condition associated with a known prothrombotic profile. We decided to evaluate whether and to what extent a diagnostic dose of desmopressin induces significant changes in endothelial parameters in patients with Cushing's disease (CD) and obese and normal weight controls. METHODS Twelve patients with CD, 10 obese and five normal weight controls were studied. Von Willebrand antigen (VWF:Ag), tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1) were measured at baseline and up to 4 h after 10 µg desmopressin i.v. RESULTS Desmopressin 10 µg transiently increased VWF:Ag and t-PA and decreased PAI-1 in all subjects. The magnitude of the VWF:Ag and t-PA increases after desmopressin was comparable in the three groups (VWF:Ag peak-to-basal ratio 1.9 ± 0.17, 1.5 ± 0.11 and 1.8 ± 0.13 and t-PA peak-to-basal ratio 1.6 ± 0.18, 1.6 ± 0.20 and 1.8 ± 0.24 for CD, obese and controls, respectively, all NS). The PAI-1 decrease observed in patients with CD was comparable with obese (0.7 ± 0.07 and 0.6 ± 0.09, NS) and controls (0.7 ± 0.07 vs. 0.4 ± 0.09, P= 0.08). CONCLUSIONS Administration of desmopressin to patients with CD for diagnostic purposes induces a transitory increase in VWF:Ag counterbalanced by a decrease in PAI-1 and increase in t-PA. The magnitude of these changes is largely comparable with that observed in obese and normal weight controls. Our data show that testing with desmopressin does not induce disease-specific changes in endothelial markers in patients with CD.
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Affiliation(s)
- Francesca Pecori Giraldi
- Cattedra di Endocrinologia, Università di Milano, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Piazzale Brescia 20, Milan, Italy.
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Lee CA, Hubbard A, Sabin CA, Budde U, Castaman G, Favaloro EJ, Friedman KD, Federici AB. Laboratory diagnosis of von Willebrand disease: results from a prospective and blind study in 32 laboratories worldwide using lyophilized plasmas. J Thromb Haemost 2011; 9:220-2. [PMID: 20946178 DOI: 10.1111/j.1538-7836.2010.04102.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- C A Lee
- University of London, London, UK
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Mattoso CRS, Takahira RK, Beier SL, Araújo JP, Corrente JE. Prevalence of Von Willebrand Disease in Dogs from São Paulo State, Brazil. J Vet Diagn Invest 2010; 22:55-60. [DOI: 10.1177/104063871002200109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aims of the current study were to assess the prevalence of von Willebrand disease (vWD) in dogs from the region of Botucatu, São Paulo State, Brazil, and to evaluate laboratory tests to diagnose this disease. The study included 350 dogs of various ages, different breeds, and both sexes. Dogs included in the study had no historical or clinical evidence of abnormal bleeding. von Willebrand factor antigen (vWF: Ag), buccal mucosal bleeding time, activated partial thromboplastin time, and factor VIII activity were evaluated in their ability to diagnose vWD. The prevalence of vWD in dogs was 1.43% in the Botucatu region of Brazil. Determination of vWF: Ag was the best laboratory test to diagnose vWD.
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Affiliation(s)
- Cláudio Roberto S. Mattoso
- School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Regina Kiomi Takahira
- School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Suzane Lílian Beier
- School of Veterinary Medicine, Agroveterinary Science Center at Santa Catarina State University, Lages, Santa Catarina, Brazil
| | - João Pessoa Araújo
- Biosciences Institute, São Paulo State University, Botucatu, São Paulo, Brazil
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FEDERICI AB, BARILLARI G, ZANON E, MAZZUCCONI MG, MUSSO R, TARGHETTA R, MANNUCCI PM. Efficacy and safety of highly purified, doubly virus-inactivated VWF/FVIII concentrates in inherited von Willebrand’s disease: results of an Italian cohort study on 120 patients characterized by bleeding severity score. Haemophilia 2010; 16:101-10. [DOI: 10.1111/j.1365-2516.2009.02088.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Batlle J, López-Fernández MF, Fraga EL, Trillo AR, Pérez-Rodríguez MA. Von Willebrand factor/factor VIII concentrates in the treatment of von Willebrand disease. Blood Coagul Fibrinolysis 2009; 20:89-100. [PMID: 19786936 DOI: 10.1097/mbc.0b013e3283254570] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Therapy for von Willebrand disease (VWD) aims to restore the hemostatic function conferred by von Willebrand factor (VWF), which facilitates platelet adhesion and aggregation, and serves to increase potentially low coagulation factor VIII (FVIII) in plasma. In patients unresponsive to desmopressin (DDAVP), the preferred treatment is with plasma-derived VWF-containing FVIII concentrates. Only a few of the available VWF/FVIII concentrates have been licensed for use in VWD based on prospective studies. The efficacy of VWF/FVIII concentrates depends on the content and quality of VWF and FVIII. Several studies have demonstrated the variability of the VWF contents, as well as the differences in the VWF multimer patterns (including the high molecular weight VWF multimers that are most effective in restoring hemostasis), among these concentrates. Treating physicians should be aware of these disparities and the potential clinical implications for patients with different VWD subtypes. Dosing has traditionally been calculated based on the FVIII content of the products, although dosing based on VWF functional activity [e.g., VWF ristocetin cofactor activity (VWF:RCo)] addresses the primary protein deficiency in VWD patients. Several clinical studies have demonstrated the efficacy of concentrates dosed according to VWF:RCo. Dosing is generally consistent across VWD subtypes, although patients with severe phenotypes or undergoing major procedures may require more infusions or longer treatment duration. Other considerations for the use of VWF-containing concentrates include laboratory monitoring of efficacy and safety issues such as thrombosis risk and thromboprophylaxis.
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Affiliation(s)
- Javier Batlle
- Servicio de Hematología y Hemoterapia, Complexo Hospitalario Universitario Juan Canalejo, Departamento de Medicina, Universidad de Santiago de Compostela, A Corunna, Spain.
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Federici AB, Canciani MT. Clinical and laboratory versus molecular markers for a correct classification of von Willebrand disease. Haematologica 2009; 94:610-5. [PMID: 19407316 DOI: 10.3324/haematol.2009.005751] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
von Willebrand disease (VWD) is the most common inherited bleeding disorder. In this perspective article, Drs. Federici and Canciani review how correlating the clinical, laboratory and genetic features of von Willebrand disease has led to improved understanding of its pathophysiology. They show how this has rationalized classification, which in turn can be used to improve treatment of these patients.
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Potential supplementary utility of combined PFA-100 and functional von Willebrand factor testing for the laboratory assessment of desmopressin and factor concentrate therapy in von Willebrand disease. Blood Coagul Fibrinolysis 2009; 20:475-83. [DOI: 10.1097/mbc.0b013e32832da1ad] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Abstract
Recent multicenter studies have clarified the molecular basis underlying the different von Willebrand disease (VWD) types, all of which are caused by the deficiency and/or abnormality of von Willebrand factor (VWF). These studies have suggested a unifying pathophysiologic concept. The diagnosis of VWD, remains difficult because its clinical and laboratory phenotype is very heterogeneous and may overlap with normal subjects. Stringent criteria are therefore required for a clinically useful diagnosis. In this paper, we delineate a practical approach to the diagnosis and treatment of VWD. Our approach is based on the critical importance of a standardized bleeding history that has been condensed into a final bleeding score and a few widely available laboratory tests, such as VWF ristocetin cofactor activity, VWF antigen and factor VIII. This approach would help identify those subjects who will probably benefit from a diagnosis of VWD. The next step involves performing a trial infusion with desmopressin in all patients who fail to exhibit an enhanced responsiveness to ristocetin. On the basis of these results and through a series of illustrative examples, the clinician will be able to select the best approach for the optimal management of VWD, according to the patient's characteristics and clinical circumstances.
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Berntorp E, Windyga J. Treatment and prevention of acute bleedings in von Willebrand disease--efficacy and safety of Wilate, a new generation von Willebrand factor/factor VIII concentrate. Haemophilia 2009; 15:122-30. [PMID: 19149848 DOI: 10.1111/j.1365-2516.2008.01901.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
For many patients with von Willebrand disease (VWD), the replacement therapy with von Willebrand factor (VWF)/factor VIII (FVIII) concentrates is the treatment of choice. To evaluate clinical efficacy, safety and tolerability of Wilate, an albumin-free VWF/FVIII concentrate with a ratio of the two haemostatic moieties of approximately 1 to 1, a prospective clinical programme has been designed. The dataset on the treatment and prevention of bleedings is derived from 44 patients (20 males and 24 females) of all VWD types. Thousand and ninety five bleeding episodes were treated with an overall efficacy rating of excellent or good in 96%. The median dose per treatment day was 26 IU FVIII:C per kg. Eighty-one per cent of bleeds were stopped within 1 or 2 days. Gastrointestinal (GI) bleeds needed higher doses (mean 44 IU kg(-1)) and longer treatment (mean 4 days). Efficacy and dosing data from eight children of 12 or less years of age did not differ significantly from the overall study population. Nineteen patients, including six children, were treated prophylactically for more than 3 months (mean 14.8, range 3-46) with a mean prophylactic dose of 27.4 IU kg(-1) and a mean frequency of 1.9 infusions per week. A drop of bleeding frequency from a mean of 4.5 to 1.4 bleeds per month was observed. The overall tolerability was very good. Adverse drug reactions were rare and were mild or moderate in their intensity. The large prospective clinical dataset shows that Wilate is efficacious and safe in the treatment and prevention of haemorrhages in all VWD types in both adult and paediatric patients.
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Affiliation(s)
- E Berntorp
- Malmö University Hospital, Malmö Centre for Thrombosis and Haemostasis, Malmö, Sweden.
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