title: Von Willebrand factor for menorrhagia: a survey and literature review.
abstract: BACKGROUND
  von Willebrand disease (VWD) is the most common congenital bleeding disorder. In women, menorrhagia is the most common bleeding symptom, and is disabling with iron deficiency anaemia, high health cost and poor quality of life. Current hormonal and non-hormonal therapies are limited by ineffectiveness and intolerance. Few data exist regarding von Willebrand factor (VWF), typically prescribed when other treatments fail. The lack of effective therapy for menorrhagia remains the greatest unmet healthcare need in women with VWD. Better therapies are needed to treat women with menorrhagia.
  
  
  METHODS
  We conducted a survey of US haemophilia treatment centres (HTCs) and a literature review using medical subject heading (MeSH) search terms 'von Willebrand factor,' 'menorrhagia' and 'von Willebrand disease' to assess the use of VWF in menorrhagia. Analysis was by descriptive statistics.
  
  
  RESULTS
  Of 83 surveys distributed to HTC MDs, 20 (24.1%) provided sufficient data for analysis. Of 1321 women with VWD seen during 2011-2014, 816 (61.8%) had menorrhagia, for which combined oral contraceptives, tranexamic acid and desmopressin were the most common first-line therapies for menorrhagia, whereas VWF was third-line therapy reported in 13 women (1.6%). Together with data from 88 women from six published studies, VWF safely reduced menorrhagia in 101 women at a dose of 33-100 IU kg(-1) on day 1-6 of menstrual cycle.
  
  
  CONCLUSIONS
  This represents the largest VWD menorrhagia treatment experience to date. VWF safely and effectively reduces menorrhagia in women with VWD. A prospective clinical trial is planned to confirm these findings.
authors: University of Pittsburgh Medical Center, Pittsburgh, PA, USA.|Hemophilia Center of Western Pennsylvania, Pittsburgh, PA, USA.
authors: M V
authors: MV
authors: Ragni
authors: University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors: N
authors: N
authors: Machin
authors: Hemophilia Center of Western Pennsylvania, Pittsburgh, PA, USA.|Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
authors: L M
authors: LM
authors: Malec
authors: Duke University Medical Center, Durham, NC, USA.
authors: A H
authors: AH
authors: James
authors: Georgetown University Medical Center, Washington, DC, USA.
authors: C M
authors: CM
authors: Kessler
authors: BloodWorks Northwest, Seattle, WA, USA.
authors: B A
authors: BA
authors: Konkle
authors: Rochester General Hosp., Rochester, NY, USA.
authors: P A
authors: PA
authors: Kouides
authors: Cleveland Clinic Foundation, Cleveland, OH, USA.
authors: A T
authors: AT
authors: Neff
authors: Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors: C S
authors: CS
authors: Philipp
authors: Research Triangle Institute International, Rockville, MD, USA.
authors: D J
authors: DJ
authors: Brambilla
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D003276:Contraceptives, Oral / Q000627:therapeutic use; D016208:Databases, Factual; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008595:Menorrhagia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D014148:Tranexamic Acid / Q000627:therapeutic use; D014842:von Willebrand Diseases / Q000150:complications / Q000188:drug therapy; D014841:von Willebrand Factor / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D003276:Contraceptives, Oral; D014841:von Willebrand Factor; D014148:Tranexamic Acid; D003894:Deamino Arginine Vasopressin
keywords: menorrhagia; von Willebrand disease; von Willebrand factor; women's health