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How I treat von Willebrand disorders in older adults.

Authors
  • Poston, Jacqueline N1, 2
  • Kruse-Jarres, Rebecca3, 4
  • 1 Division of Hematology/Oncology, Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT.
  • 2 Division of Clinical Pathology, Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT.
  • 3 Washington Center for Bleeding Disorders, Seattle, WA.
  • 4 Division of Hematology, Department of Medicine, University of Washington, Seattle, WA.
Type
Published Article
Journal
Blood
Publisher
American Society of Hematology
Publication Date
Jan 18, 2024
Volume
143
Issue
3
Pages
197–204
Identifiers
DOI: 10.1182/blood.2022018534
PMID: 37672774
Source
Medline
Language
English
License
Unknown

Abstract

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. © 2024 American Society of Hematology. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

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