title: Treatment of von Willebrand disease with a high-purity factor VIII/von Willebrand factor concentrate: a prospective, multicenter study.
abstract: Among patients with von Willebrand disease (VWD) who are unresponsive to desmopressin therapy, replacement with plasma-derived concentrates is the treatment of choice. Because prospective studies are lacking, such treatment has been largely empirical. A multicenter, prospective study has been conducted in 81 patients with VWD (15 patients with type 1, 34 with type 2, and 32 with type 3 disease) to investigate the efficacy of a high-purity factor VIII/von Willebrand factor (FVIII/VWF) concentrate for treatment of bleeding and surgical prophylaxis. Two preparations of the concentrate-one virally inactivated with solvent detergent, the other with an additional heat-treatment step--were evaluated. Pharmacokinetic parameters were similar for both preparations. Using pre-established dosages based on the results of pharmacokinetic studies, 53 patients were administered either preparation for the treatment of 87 bleeding episodes, and 39 patients were treated prophylactically for 71 surgical or invasive procedures. Sixty-five (74.7%) and 10 (11.5%) of the bleeding episodes were controlled with 1 or 2 infusions, respectively. Patients with severe type 3 VWD typically required more infusions and higher doses, at shorter time intervals, than did patients with generally milder types 1 and 2. Among patients undergoing surgical procedures, blood loss was lower than that predicted prospectively, and losses exceeding the predicted value did not correlate with the postinfusion skin bleeding time. In conclusion, the concentrate effectively stopped active bleeding and provided adequate hemostasis for surgical or invasive procedures, even in the absence of bleeding time correction.
authors.affiliation: Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Maggiore Hospital and University of Milan, Italy.
authors.forename: Pier M
authors.initials: PM
authors.lastname: Mannucci
authors.forename: Juan
authors.initials: J
authors.lastname: Chediak
authors.forename: Wahid
authors.initials: W
authors.lastname: Hanna
authors.forename: John
authors.initials: J
authors.lastname: Byrnes
authors.forename: Marlies
authors.initials: M
authors.lastname: Ledford
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Ewenstein
authors.forename: Anastassios D
authors.initials: AD
authors.lastname: Retzios
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Kapelan
authors.forename: Richard S
authors.initials: RS
authors.lastname: Schwartz
authors.forename: Craig
authors.initials: C
authors.lastname: Kessler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002648:Child; D018592:Cross-Over Studies; D003902:Detergents; D004305:Dose-Response Relationship, Drug; D017558:Elective Surgical Procedures; D005169:Factor VIII / Q000302:isolation & purification / Q000493:pharmacokinetics / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006358:Hot Temperature; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012449:Safety; D012997:Solvents; D013924:Thrombophlebitis / Q000209:etiology; D014081:Tooth Extraction; D016896:Treatment Outcome; D014842:von Willebrand Diseases / Q000188:drug therapy*; D014841:von Willebrand Factor / Q000737:chemistry / Q000302:isolation & purification / Q000493:pharmacokinetics / Q000627:therapeutic use*
chemical_list: D003902:Detergents; D012997:Solvents; D014841:von Willebrand Factor; D005169:Factor VIII