title: Percutaneous coronary intervention and the management of acute coronary syndromes in patients with von Willebrand disease.
abstract: BACKGROUND
  Von Willebrand disease (vWD) results from quantitative or qualitative deficiency of von Willebrand factor (vWF). The occurrence of myocardial infarction is very rare in patients with vWD. A few case reports of acute coronary syndrome (ACS) in vWD patients are present in the literature, but no definite management recommendations are available for such patients.
  
  
  METHODS
  We report a case of successful percutaneous coronary intervention (PCI) with bare-metal stent (BMS) implantation in a 46-year-old woman with type 1 vWD and history of coronary artery disease (CAD). She received periprocedural dual-antiplatelet therapy for 2 weeks and then continued aspirin without any bleeding complications.
  The optimal management of patients with vWD and ACS is complex and presents a therapeutic challenge. We propose that dual-antiplatelet therapy can be used safely in most vWD patients presenting with ACS as most of them are type 1 vWD. PCI with BMS can be done safely. Long-term management of these patients requires a systemic approach including hematological consultation, ascertaining vWF levels, as well as patient education and close outpatient follow-up.
authors.affiliation: Cardiology Section, Virginia-Tech Carilion School of Medicine and Research Instituite, Roanoke, Virginia, USA. srathore@carilionclinic.org
authors.forename: Sulaiman
authors.initials: S
authors.lastname: Rathore
authors.forename: Dexter
authors.initials: D
authors.lastname: Deleon
authors.forename: Hafsa
authors.initials: H
authors.lastname: Akram
authors.forename: David
authors.initials: D
authors.lastname: Sane
authors.forename: Timothy
authors.initials: T
authors.lastname: Ball
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000628:therapy*; D015897:Comorbidity; D019468:Disease Management; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D010353:Patient Education as Topic; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome; D014842:von Willebrand Diseases / Q000453:epidemiology*
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors