Management of inherited von Willebrand Disease in Italy: Results from the retrospective study on 1234 patients

Augusto B. Federici, Paolo Bucciarelli, Giancarlo Castaman, Luciano Baronciani, Maria T. Canciani, Maria G. Mazzucconi, Massimo Morfini, Angiola Rocino, Mario Schiavoni, Emily Oliovecchio, Alfonso Iorio, Pier M. Mannucci

Research output: Contribution to journalArticle

Abstract

von Willebrand disease (VWD) is the most common inherited bleeding disorder and is due to quantitative and/or qualitative defects of von Willebrand factor (VWF). Despite the improved knowledge of the disease, detailed data on VWD types requiring specific treatments have not been reported thus far. To determine the number and types of VWD requiring therapy with desmopressin (DDAVP) and/or VWF/FVIII concentrates in Italy, a national registry on VWD (RENAWI) was organized. Only 16 of 48 centers included VWD in the RENAWI with diagnoses performed locally. Patients with uncertain results were retested by two expert laboratories using multimeric analysis and mutations of the VWF gene. A total of 1234 of 1529 (81%) cases satisfied the inclusion criteria and could be classified as VWD1 (63%), VWD2A (7%), VWD2B (6%), VWD2M (18%), VWD2N (1%), and VWD3 (5%). VWD types were also confirmed by DNA analyses and occur in young adults (83%), mainly in women (58%). Mucosal bleedings (32 to 57%) are more frequent than hematomas (13%) or hemarthrosis (6%). Most patients were exposed to an infusion trial with desmopressin (DDAVP) and found responsive with the following rates: VWD1 (69%), VWD2A (26%), VWD2M (29%), and VWD2N (71%). However, DDAVP was not always used to manage bleeding in all responsive patients and VWF/FVIII concentrates were given instead of or together with DDAVP in VWD1 (30%), VWD2A (84%), VWD2B (62%), VWD2M (63%), VWD2N (30%), and VWD3 (91%). Data of the RENAWI showed that correct VWD identification and classification might be difficult in many Italian centers. Therefore, evidence-based studies should be organized only in well-characterized patients tested by laboratories that are expert in the clinical, laboratory, and molecular markers of VWD.

Original languageEnglish
Pages (from-to)511-521
Number of pages11
JournalSeminars in Thrombosis and Hemostasis
Volume37
Issue number5
DOIs
Publication statusPublished - 2011

Keywords

  • clinical
  • desmopressin
  • laboratory and molecular markers
  • mucosal bleeding
  • von Willebrand disease
  • von Willebrand factor assays
  • VWF/FVIII concentrates

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Federici, A. B., Bucciarelli, P., Castaman, G., Baronciani, L., Canciani, M. T., Mazzucconi, M. G., Morfini, M., Rocino, A., Schiavoni, M., Oliovecchio, E., Iorio, A., & Mannucci, P. M. (2011). Management of inherited von Willebrand Disease in Italy: Results from the retrospective study on 1234 patients. Seminars in Thrombosis and Hemostasis, 37(5), 511-521. https://doi.org/10.1055/s-0031-1281037