This protocol covers patients with Von Willebrand disease who also have cardiovascular disease and a clinical indication for antiplatelet or anticoagulant therapy — a setting where the elevated bleeding risk of VWD must be weighed against the need for cardiovascular treatment.
When patients with VWD carry a concurrent cardiovascular indication for antiplatelet or anticoagulant therapy, evidence-based guidance supports giving that therapy rather than withholding it. Patients with a severe VWD bleeding phenotype represent a particularly important subgroup addressed by this protocol.
The regimen involves administering the indicated antiplatelet or anticoagulant therapy, with additional haemostatic management considerations that apply to specific patient subgroups — the full criteria, sequencing, and individualised steps are in the complete protocol.
DOI: 10.1182/bloodadvances.2020003264.
In patients with VWD and cardiovascular disease who require treatment with antiplatelet agents or anticoagulant therapy, the panel suggests giving the necessary antiplatelet or anticoagulant therapy over no treatment (conditional recommendation based on low certainty in the evidence of effects).
Patients with a severe bleeding phenotype (eg, severe type 1, type 2, or type 3 VWD) may require prophylaxis with VWF concentrate to prevent bleeding while on antiplatelet or anticoagulant therapy; similar precautions may apply to patients with type 1 VWD and concurrent additional bleeding problems.
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