Saturday, June 22, 2024

Challenges and Treatments for Gastrointestinal Bleeding in von Willebrand Disease

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Gastrointestinal (GI) bleeding in individuals with von Willebrand disease (VWD) presents significant diagnostic challenges and frequently recurs. This study aims to shed light on the current treatment approaches and outcomes for these GI bleeding episodes (BEs), emphasizing the necessity for more robust clinical data and treatment consensus.

Study Overview and Methods

A retrospective, observational, multicenter chart review was conducted between January 2018 and December 2019, involving patients with inherited VWD who experienced at least one GI BE in the previous five years. Researchers analyzed baseline characteristics, the number and causes of BEs, associated GI-specific morbidities or lesions, and treatment outcomes.

The study included 20 patients with various types of VWD: 20% had type 1, 50% had type 2, and 30% had type 3. A total of 60 bleeding episodes were documented, with 52% having a single identified or suspected cause and 18% presenting multiple causes.

Treatment Efficacy and Outcomes

Most GI BEs (72%) were managed with a combination of von Willebrand factor (VWF), antifibrinolytics, and other treatments. The resolution time for BEs did not significantly differ between those treated with VWF and those treated with non-VWF methods, although non-VWF treatments tended to resolve later. In patients with GI-specific morbidities or lesions, 84% of BEs resolved with first-line treatment, albeit with a longer resolution time compared to patients without such conditions.

Among the patients, 13 BEs occurred in those receiving prophylaxis, while 47 were in patients treated on-demand. Following bleed resolution, 18 BEs led to a switch to prophylactic treatment.

Key Inferences

Key takeaways from this study include:

  • The combination therapy of VWF and antifibrinolytics is frequently used but may not be superior in resolution time compared to non-VWF treatments.
  • GI-specific morbidities prolong the time to resolution despite effective first-line treatments.
  • On-demand treatment might result in more frequent bleeding events compared to prophylactic treatment, highlighting the potential benefits of prophylaxis.

This study underscores the pressing need for prospective research to address the management of recurrent GI BEs in VWD patients, particularly focusing on prophylactic measures.

Original Article: Haemophilia. 2024 May 15. doi: 10.1111/hae.15034. Online ahead of print.

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