Analysis of current perioperative management with Haemate® P/Humate P® in von Willebrand disease: Identifying the need for personalized treatment. Issue 3 (24th March 2018)

• Record Type: Journal Article
• Authors: Hazendonk, H. C. A. M.; Heijdra, J. M.; de Jager, N. C. B.; Veerman, H. C.; Boender, J.; van Moort, I.; Mathôt, R. A. A.; Meijer, K.; Laros‐van Gorkom, B. A. P.; Eikenboom, J.; Fijnvandraat, K.; Leebeek, F. W. G.; Cnossen, M. H.
• Is Part Of: Haemophilia. Volume 24:Issue 3(2018)
• Page Start: 460
• Page End: 470
• Publication Date: 2018-03-24
• Subjects: individualized medicine -- surgery -- therapy -- von Willebrand Disease -- von Willebrand factor (MESH entry database); Hemophilia -- Periodicals; 616.1572005
• DOI: 10.1111/hae.13451
• Languages: English
• ISSNs: 1351-8216

Abstract

Abstract : Introduction: Patients with Von Willebrand disease (VWD) are regularly treated with VWF‐containing concentrates in case of acute bleeding, trauma and dental or surgical procedures. Aim: In this multicentre retrospective study, current perioperative management with a von Willebrand factor (VWF)/Factor VIII (FVIII) concentrate (Haemate ® P) in patients with VWD was evaluated. Patients/Methods: Patients with VWD undergoing minor or major surgery between 2000 and 2015, requiring treatment with a VWF/FVIII concentrate (Haemate ® P), were included. Achieved VWF activity (VWF:Act) and FVIII during FVIII‐based treatment regimens were compared to predefined target levels in national guidelines. Results: In total, 103 patients with VWD (148 surgeries) were included: 54 type 1 (73 surgeries), 43 type 2 (67 surgeries) and 6 type 3 (8 surgeries). Overall, treatment resulted in high VWF:Act and FVIII levels, defined as ≥0.20 IU/mL above predefined levels. In patients with type 1 VWD, respectively, 65% and 91% of trough VWF:Act and FVIII levels were higher than target levels. In patients with type 2 and type 3 VWD, respectively, 53% and 57% of trough VWF:Act and 72% and 73% of trough FVIII levels were higher than target level. Furthermore, FVIII accumulation over time was observed, while VWF:Act showed a declining trend, leading to significantly higher levels of FVIII than VWF:Act. Conclusion: High VWF:Act and accumulation of FVIII were observed after perioperative FVIII‐based replacement therapy in patients with VWD, both underlining the necessity of personalization of dosing regimens to optimize perioperative treatment.