Von Willebrand's Disease

Treatment Overview

Treatment for von Willebrand's disease can vary based on the type of disease, severity of symptoms, or risk of heavy bleeding. If you have a mild type, you may only need home treatment like not taking aspirin. At other times, you may need medicine to prevent heavy bleeding when you have an injury, are having surgery, or are about to give birth.

If you have a more severe type of von Willebrand's disease, you likely will need to prevent and treat bleeding episodes throughout your life.

The course of von Willebrand's disease is hard to predict because it may stay at the same level of activity or get better or worse as you get older.

Medicines to increase the von Willebrand factor in your blood and to prevent the breakdown of blood clots treat all types of von Willebrand's disease. But there is no cure for this disease.

Treatment for von Willebrand's disease may consist of:

• Desmopressin to help the body make more von Willebrand factor, to reduce blood loss during a woman's menstrual periods, to lower blood loss during a surgery, and to help control bleeding episodes. Because the effects of this medicine can vary, your doctor will prescribe it on a trial basis to see how much it increases the amount of clotting factors in your blood and to monitor side effects.
• Therapies to replace the clotting factors in your blood. Replacement therapy injections (infusions) may be used with people who:
  • Do not respond to desmopressin.
  • Cannot tolerate desmopressin.
  • Have severe type 2 or 3 von Willebrand's disease.
  If you have type 3 von Willebrand's disease, you may be taught to inject yourself with blood-clotting factors. If you can give yourself a shot as soon as a bleeding episode starts, you can avoid losing too much blood and prevent any permanent damage that could be caused by the bleeding.
• Antifibrinolytic agents that help prevent the breakdown of blood clots. Antifibrinolytic medicines can be used alone or in combination with desmopressin medicine or replacement therapy to treat mild bleeding. These medicines are sometimes used to prevent bleeding during surgery.
• Birth control pills (oral contraceptives) or a levonorgestrel IUD to help control heavy menstrual periods in women who have von Willebrand's disease. Birth control pills and this IUD contain hormones that help reduce blood loss during a woman's period.
• Topical medicine to control very mild bleeding in the mouth or nose. Thrombin powder is a dry powder that you can apply directly on a wound to help it clot. It is especially useful during dental procedures.
• Avoiding medicines that can affect bleeding. These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin.

Your doctor may combine some of these treatments, depending on how the disease affects you.

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Author:	Robin Parks, MS	Last Updated: November 24, 2008
Medical Review:	Anne C. Poinier, MD - Internal Medicine Joseph O'Donnell, MD - Hematology/Oncology
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