In von Willebrand disease, what perioperative management is typically required?

• A. Perioperative vWF and factor VIII replacement is required
• B. No special management needed
• C. Perioperative aspirin is required
• D. Only desmopressin is sufficient

Answer: (B)

Perioperative care for von Willebrand disease focuses on ensuring adequate von Willebrand factor and factor VIII levels at the time of surgery, because the defect impairs both platelet adhesion and clot formation. If the patient is responsive to desmopressin, a dose can be given preoperatively to release stored vWF and FVIII, which works well for many minor procedures. If there is poor response to desmopressin or if the patient has type 3 VWD (or certain type 2 variants), replacement with a plasma-derived vWF-containing factor VIII concentrate is used to achieve target levels. Avoid aspirin and other antiplatelet drugs perioperatively, and consider antifibrinolytics like tranexamic acid to reduce mucosal bleeding. Local hemostasis and careful surgical technique remain important, but they are supported by pharmacologic strategies to raise and maintain hemostatic factor levels. Assuming no special management is needed would miss these critical steps to prevent bleeding.