Treating von Willebrand Disease

vWD Treatment Overview

Your doctor will decide what treatment you need based on the type of von Willebrand disease (vWD) you have and how severe it is. Most cases of vWD are mild, and you may need treatment only if you have surgery, a tooth extraction or an accident. Each type of vWD requires its own treatment plan. The treatment for vWD includes topical hemostatic agents and pressure dressings for mild, superficial bleeding. If bleeding is more severe, vWF levels need to be increased.

Medicines are used to:

Increase the release of von Willebrand factor and factor VIII into the bloodstream
Replace von Willebrand factor
Prevent the breakdown of clots
Control heavy menstrual bleeding in women

Types of Treatments

Desmopressin (DDAVP) is a synthetic hormone that you usually take by injection or nasal spray. It makes your body release more von Willebrand factor and factor VIII into your bloodstream. DDAVP works for most patients who have type 1 VWD and for some who have type 2 VWD. Each person needs to have a test dose to determine their individual response to these products. These agents do not work for type 3.

Von Willebrand factor replacement therapy is an infusion of a concentrate of von Willebrand factor and factor VIII into a vein in your arm. This treatment can be used if you:

Can’t take DDAVP or need extended treatment
Have type I VWD that doesn’t respond to DDAVP
Have type II or type III vWD

Antifibrinolytic drugs help prevent the breakdown of blood clots. They’re mostly used to stop bleeding after minor surgery, tooth extraction or an injury. They may be used alone or together with DDAVP and replacement therapy.

Fibrin glue is medicine that’s placed directly on a wound to stop the bleeding.

Treatments for Women

Treatments for women who have vWD with heavy menstrual bleeding include:

Combined oral contraceptives (birth control pills). The hormones in these pills can increase the amount of von Willebrand factor and factor VIII in your bloodstream and reduce menstrual blood loss. They’re the most recommended birth control method for women with vWD.
A levonorgestrel intrauterine device. This is a contraceptive device that contains progestin. It’s placed in the uterus (womb).
Aminocaproic acid or tranexamic acid. These antifibrinolytic drugs can reduce bleeding by slowing the breakdown of blood clots.
DDAVP

For some women who are done having children or don’t want children, endometrial ablation is performed. This procedure destroys the lining of the uterus. It has been shown to reduce menstrual blood loss in women with vWD.

If you need a hysterectomy (surgical removal of the uterus) for another reason, this procedure will stop menstrual bleeding and possibly improve your quality of life. However, a hysterectomy carries its own risk of bleeding complications.