Von Willebrand Disease in Females Requiring or Desiring Neuraxial Anesthesia During Labor

Clinical Scenario

This protocol addresses female patients with Von Willebrand disease (VWD) who require or desire neuraxial anesthesia — such as an epidural — during labor. VWD introduces hemostatic risk at catheter insertion and removal, making proactive management essential before this procedure can proceed safely.

Treatment Approach

Management involves VWF concentrate therapy to raise and sustain VWF activity within a defined therapeutic range. Monitoring is required throughout the period that the neuraxial catheter remains in place and continues into the post-removal window.

The complete protocol — including the precise targets, timing, monitoring intervals, and decision thresholds — is available via the link below.

Clinical Goals

The objective is to achieve and maintain VWF activity within a safe, specified range while the epidural is in place and for a defined period following catheter removal. Activity falling below the therapeutic threshold during either phase increases bleeding risk at the neuraxial site.

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References

In women with VWD for whom neuraxial anesthesia during labor is deemed suitable, the panel suggests targeting a VWF activity level of 0.50 to 1.50 IU/mL over targeting an activity level of >1.50 IU/mL to allow neuraxial anesthesia (conditional recommendation based on very low certainty in the evidence of effects).
VWF activity levels should be maintained at >0.50 IU/mL while the epidural is in place and for at least 6 hours after removal.

DOI: 10.1182/bloodadvances.2020003264.

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