Even though von Willebrand disease is a lifelong condition with no cure, your doctor can treat it effectively. Treatment may vary depending on the type and severity of the disorder, as well as your response to previous therapy and other medications you may be taking. The most commonly used treatments for von Willebrand disease include:
Desmopressin (DDAVP). This medication is administered by injection into a vein or, more commonly, through a nasal spray called Stimate. It's a synthetic hormone, similar to the natural hormone vasopressin, that controls bleeding by stimulating your body to release more von Willebrand factor already stored in the lining of your blood vessels — thereby enhancing factor VIII levels. DDAVP is usually effective in people with type 1 and some subtypes of type 2 disease.
Many doctors consider DDAVP the first treatment to use in the management of von Willebrand disease. Some women use the nasal spray at the beginning of their menstrual periods to control excessive bleeding. You can also use it before a minor surgical procedure.
- Replacement therapies. These consist of infusions of prepared doses of concentrated blood-clotting factors containing von Willebrand factor and factor VIII. They can be useful in all disease types, and your doctor may recommend them if DDAVP isn't effective or particularly if you need treatment for more-severe forms of the disease.
- Contraceptives. These can be useful for controlling heavy bleeding during your menstrual periods. The estrogen hormones present in birth control pills can boost levels of von Willebrand factor and factor VIII activity. Another option your doctor may recommend is the placement in your uterus of a progesterone-containing contraceptive device, such as Mirena.
- Anti-fibrinolytic or clot-stabilizing medications. These medications, such as aminocaproic acid (Amicar) and tranexamic acid (Cyklokapron; Lysteda, others), can slow down the breakdown of clotting factors. This can help keep a clot in place once it has formed, putting a stop to bleeding. Doctors often prescribe these drugs before or after a surgical procedure or tooth extraction.
- Fibrin sealants. These substances, applied like a glue using syringes, are placed directly on a cut to curtail bleeding.
If your condition is mild, your doctor might recommend treatment only when you're undergoing surgery or dental extractions or when you've experienced trauma (in an automobile accident, for example).
Jan. 02, 2014
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