From the Research
Stroke thrombectomy poses significant risks in patients with von Willebrand factor (vWF) deficiency, primarily due to the heightened bleeding risk associated with this condition. Before proceeding with thrombectomy in these patients, hematology consultation is strongly recommended to optimize clotting factors. Treatment typically involves administering von Willebrand factor concentrate (such as Humate-P or Wilate) to achieve vWF levels of at least 50-100% before the procedure, as supported by a study on the efficacy and safety of a recombinant Von Willebrand Factor treatment in patients with inherited Von Willebrand Disease requiring surgical procedures 1. For minor procedures, a single dose may be sufficient, while major interventions might require maintaining these levels for 7-14 days. Desmopressin (DDAVP) at 0.3 mcg/kg IV may be considered for mild type 1 vWF deficiency but is not effective for type 2B or type 3 disease. The anesthesiologist and interventional team should be informed about the patient's condition, and post-procedure monitoring for bleeding complications should be intensified.
Key considerations in managing these patients include:
- The role of vWF in platelet adhesion and as a carrier protein for factor VIII, making both primary and secondary hemostasis vulnerable in these patients, potentially leading to excessive bleeding during or after the invasive procedure.
- The importance of individualized risk assessment for thromboprophylaxis in patients with vWF deficiency undergoing surgical procedures, as highlighted in a study on antithrombotic prophylaxis in patients with von Willebrand disease undergoing major surgery 2.
- The potential for vWF levels to predict outcome in subjects with acute coronary syndromes, stroke, and perhaps atrial fibrillation, as discussed in a review on the role of von Willebrand Factor in CHD and stroke 3.
- The therapeutic inhibition of VWF by novel agents as a promising approach for secondary prevention of stroke recurrence in specific sub-groups of patients, such as those suffering from large artery atherosclerosis, as noted in a study on targeting von Willebrand Factor in Ischaemic Stroke 4.
Overall, the management of patients with vWF deficiency undergoing stroke thrombectomy requires careful consideration of their coagulation status and individualized approaches to minimize the risk of bleeding complications, as informed by the most recent and highest quality evidence available 5.