Table 3.

VWD therapeutic management

VWD treatment considerations
Is desmopressin likely to be effective?	• Baseline VWF level >10%
	• Conduct desmopressin trial (IV, SC, IN)
	• Test VWF:Ag, VWF:RCo, and FVIII:C levels at 1, 2, and 4 hours
	• Positive response both FVIII and VWF > 50% after administration
Addition of adjunctive therapies	• Antifibrinolytics
	• For menorrhagia: oral contraceptive or levonorgestrel-releasing IUD
VWF concentrates	• If desmopressin response is inadequate
	• If desmopressin is required for several consecutive days
	• Dosing/product considerations
	VWF/FVIII ratio
	VWF multimer profile
	Dosing by VWF:RCo or FVIII:C
	Potential for prophylactic schedule
	Rare development of VWF alloantibodies