How does von Willebrand disease influence surgical bleeding risk assessment?

• A. Increases risk of mucosal and surgical bleeding; requires perioperative vWF and factor VIII management.
• B. Decreases risk; no special management
• C. Only mucosal bleeding risk increases; no perioperative management
• D. Increases surgical bleeding risk but not mucosal; no vWF management

Answer: (A)

Von Willebrand disease reduces von Willebrand factor, which is essential for platelets to adhere to damaged vessels and for stabilizing factor VIII. This dual effect means patients have a tendency for mucosal bleeding (epistaxis, gum bleeding, bruising) and, when surgery is performed, an increased risk of oozing and excessive bleeding at the surgical site. Because of this, perioperative management aims to raise circulating levels of von Willebrand factor and factor VIII to achieve adequate hemostasis. Desmopressin (DDAVP) is often used in responsive patients to release endogenous vWF and FVIII, while vWF-containing factor VIII concentrates are used in others or for major procedures. Preoperative testing of vWF activity and factor VIII helps tailor the plan and ensure sufficient hemostatic protection during and after surgery.