From the Research
Antiplatelet therapy may be considered in patients with von Willebrand disease when their von Willebrand factor activity levels are at least 50% through appropriate replacement therapy, as recommended by recent guidelines 1. The management of patients with von Willebrand disease (VWD) who require antiplatelet therapy is complex and requires a multidisciplinary approach, involving both hematology and cardiology.
- Key considerations include the type and severity of VWD, the patient's thrombotic risk, and the clinical indication for antiplatelet therapy.
- According to the ASH ISTH NHF WFH 2021 guidelines on the management of VWD, the use of antiplatelet agents should be individualized based on the patient's specific condition and the risk of bleeding versus thrombosis 1.
- A systematic review of desmopressin as a treatment in patients with VWD found that it can be effective in increasing VWF activity levels, but the decision to use antiplatelet therapy should be made on a case-by-case basis, taking into account the patient's overall clinical condition 2.
- The National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report also emphasizes the importance of individualized management of VWD, including the use of antiplatelet therapy, and highlights the need for further research in this area 3.
- In general, antiplatelet medications like aspirin, clopidogrel, or ticagrelor may be considered when VWF activity levels are within or approaching the normal range (50-200%), but the decision should be based on a thorough assessment of the patient's risk of bleeding and thrombosis, as well as their overall clinical condition 4.