rVWF prophylaxis during elective surgery
A multinational trial involving eleven centres, including NHS services in Oxford and London, has shown that recombinant von Willebrand factor (rVWF) is safe and effective as prophylaxis during elective surgery in people with severe von Willebrand’s disease. Fifteen patients undergoing major, minor or oral surgery received rVWF 40-60 IU/kg one hour before surgery and postoperatively to maintain target trough levels. This was given as monotherapy if target levels of factor VIII were achieved before surgery (89% of patients) or, if not, combined with recombinant FVIII. Overall, 70% of procedures did not require additional FVIII.
Haemostatic efficacy during surgery was rated as excellent (73% with rVWF alone and 87% with rVWF/rFVIII) or good (27% and 13%). rVWF achieved haemostatically effective levels of endogenous FVIII within 6 hours and these were sustained for 72 – 96 hours. A serious adverse event occurred in two patients: diverticulitis (unrelated to treatment) and deep vein thrombosis (possibly treatment-related).