Recombinant von Willebrand factor: a new tool to manage von Willebrand disease in obstetric patients

Recombinant von Willebrand factor: a new tool to manage von Willebrand disease in obstetric patients V on Willebrand disease (VWD) is estimated to affect approximately 1.3% of the population, 1 and many of these patients will inevitably become pregnant.Parturients with VWD often have a higher incidence of menorrhagia and an increased risk of postpartum hemorrhage compared to the general population. 2 While the risk of epidural hematoma from neuraxial analgesia during labor/delivery is estimated to be around 1 in 168,000, 3 the impact of coinciding VWD on this rare complication is unknown.Traditionally, patients with low levels of VWD have been treated with von Willebrand factor (VWF) derived from human plasma. 4However, recombinant von Willebrand factor (rVWF) derived from laboratory synthesis has shown promise as a substitute for VWF. 5 Sharpe et al present a case series that provides insight into the use of this novel agent in obstetric patients. 6he authors of this study retrospectively identified patients at their tertiary institution who had a VWD subtype with defects only in VWF and not factor VIII.These patients all ultimately received rVWF prior to placement of neuraxial analgesia or anesthesia for delivery.The benefits of administering rVWF in obstetric patients compared to VWF include decreasing pathogen exposure and avoiding overcorrection of factor VIII.The longer half-life of rVWF may make it more costeffective than plasma-derived VWF. 7In the present study, the infusion of rVWF corrected the VWF activity defects that were present among all participants, and neuraxial analgesia was safely utilized.While no adverse events occurred from rVWF, the study size was too small to capture uncommon complications.The use of rVWF is also only beneficial for a particular subset of VWD patients (type I and II who do not have factor VIII deficiencies), so care must be taken to identify these specific patients prior to delivery planning.However, this study does provide reassurance that use of rVWF in obstetric patients with VWD may be useful in decreasing postpartum hemorrhage, allows for the safe placement of neuraxial anesthesia, and avoids the unique potential complications of VWF derived from human plasma.