Advances in the diagnosis and treatment of Von Willebrand disease

Abstract

Von Willebrand disease (VWD) is the most common inherited bleeding disorder, yet diagnosis and management remain challenging. Development and use of bleeding assessment tools allows for improved stratification of which patients may require further assessment and which patients are most likely to require treatment of their VWD. New options for laboratory assessment of von Willebrand factor (VWF) activity include a new platelet-binding assay, the VWF:GPIbM, which is subject to less variability than the ristocetin cofactor activity assay, and collagen-binding assays that provide insight into a different function of VWF. Genetic testing may be helpful in some cases where a type 2 VWD variant is suspected but is usually not helpful in type 1 VWD. Finally, treatment options for VWD are reviewed, including the use of recombinant VWF. Despite these advances, still more work is required to improve diagnosis, treatment, and quality of life for affected patients.

Figure 1.

Genetic variants in VWF in type 1 VWD. Frequency of genetic variants in VWF for 5 large population studies of type 1 VWD including the United Kingdom, European Union, Canada, Germany, and United States. Overall 65% had a variant in VWF found, but 35% did not.