From the Guidelines
To prevent easy bruising in patients with von Willebrand disease type 1, desmopressin (DDAVP) is the primary treatment option, as it enhances platelet adherence and platelet aggregate growth on human artery subendothelium, as noted in the study published in Critical Care in 2013 1.
Treatment Options
The following treatment options can be considered:
- DDAVP can be administered as a nasal spray (Stimate) at 150-300 mcg per dose or intravenously at 0.3 mcg/kg.
- For minor bleeding or before procedures, a single dose is typically sufficient, while more significant bleeding may require doses every 12-24 hours for 2-3 days.
- Patients should also take tranexamic acid (Lysteda) 1000-1300 mg orally three times daily during menstruation or bleeding episodes to stabilize clots.
Daily Preventive Measures
Daily preventive measures include:
- Avoiding medications that affect platelet function, such as aspirin, NSAIDs, and certain supplements like fish oil and vitamin E.
- Maintaining adequate iron intake through diet or supplements to prevent anemia from chronic blood loss.
- Physical protection is important—wearing protective gear during activities, using an electric razor instead of blades, and applying pressure to injuries for at least 5 minutes.
Rationale
These interventions work by either increasing von Willebrand factor levels (DDAVP), stabilizing formed clots (tranexamic acid), or physically preventing trauma that could lead to bruising, as supported by the guidelines published in the American Journal of Hematology in 2009 1.
From the FDA Drug Label
Desmopressin Acetate Injection is indicated for patients with mild to moderate von Willebrand's disease (Type I) with factor VIII levels greater than 5% to: Maintain hemostasis during surgical procedures and postoperatively Reduce bleeding with episodes of spontaneous or traumatic injuries such as hemarthroses, intramuscular hematomas, or mucosal bleeding
Desmopressin can help prevent easy bruising in patients with von Willebrand type 1 by:
- Maintaining hemostasis during surgical procedures and postoperatively
- Reducing bleeding with episodes of spontaneous or traumatic injuries Desmopressin is indicated for patients with mild to moderate von Willebrand's disease (Type I) with factor VIII levels greater than 5% 2, 3, 2.
From the Research
Preventing Easy Bruising in Patients with Von Willebrand Type 1
To prevent easy bruising in patients with Von Willebrand Type 1, the following measures can be taken:
- Desmopressin can be used to prevent bleeding in Von Willebrand disease (VWD) as it corrects the dual defects of hemostasis, namely abnormal coagulation expressed by low levels of factor VIII and abnormal platelet adhesion expressed by the reduction of VWF 4.
- The relationship between desmopressin dose, its plasma concentration, and the VWF:Act response in type 1 VWD patients has been quantified, and simulations demonstrate that after 0.3 mcg/kg desmopressin intravenously, >90% patients with a VWF:Act baseline of ≥0.20 IU/mL attain a VWF:Act >0.5 IU/ml up to ≥4 h after administration 5.
- Desmopressin is the treatment of choice for most patients with type 1 VWD because it can induce release of normal VWF from cellular compartments 6.
- A test dose of desmopressin at the time of diagnosis is recommended to establish the individual patterns of biological response and to predict clinical efficacy during bleeding and surgery 6.
Treatment Options
The treatment options for preventing easy bruising in patients with Von Willebrand Type 1 include:
- Desmopressin, which raises endogenous factor VIII and von Willebrand factor three- to fivefold and thereby transiently corrects both the intrinsic coagulation and primary hemostasis defects 7, 8.
- Plasma concentrates containing factor VIII and von Willebrand factor, which can be used in patients who are unresponsive to desmopressin or have severe forms of VWD 7, 8.
Dosage and Administration
The dosage and administration of desmopressin for preventing easy bruising in patients with Von Willebrand Type 1 include: