PFA-100 monitoring of von Willebrand factor (VWF) responses to desmopressin (DDAVP) and factor VIII/VWF concentrate substitution in von Willebrand disease type 1 and 2

Thromb Haemost. 2008 Sep;100(3):462-8.

Abstract

Dose-response relationship was studied between PFA-100 closure times (PFA CTs) and factor (F)VIII-von Willebrand factor (VWF) parameters in patients with von Willebrand disease (VWD) type 1 and type 2 before and after treatment with DDAVP (n=84) or FVIII/VWF concentrate (n=38). DDAVP treatment of patients with VWD type 1 normalised the PFA CTs by increasing VWF levels to normal. Of the 14 patients with VWD type 2, PFA CTs did not normalize in eight. Haemate-P substitution in patients with VWD type 1 induced a less favourable response as compared to DDAVP, because PFA CTs did not correct in all patients. Of 12 patients with VWD type 2 treated with Haemate-P, six showed a correction of PFA CTs (<250 sec), which correlated with the normalisation of the VWF CB/Ag ratio. In-vitro studies were performed by using whole blood of patients with VWD and adding various amounts of FVIII/VWF concentrate. Addition of Haemate-P induced an increase of the VWF CB/Ag ratio from 0.30 to 0.70 in blood of patients with VWD type 2 with correction of the PFA CTs. Immunate did not result in an increase of VWF CB/Ag ratio in blood of VWD type 2 patients, and the PFA CTs remained prolonged. We conclude that PFA-100 might be an adequate instrument not only for diagnosis but also for monitoring of DDAVP responses and FVIII/VWF substitution of patients with VWD type 1 and 2, but this is dependent upon the type of VWD and the concentrate used.

MeSH terms

  • Blood Platelets / metabolism
  • Coagulants
  • Collagen / chemistry
  • Deamino Arginine Vasopressin*
  • Factor VIII / biosynthesis*
  • Hemostatics
  • Humans
  • Platelet Adhesiveness
  • Platelet Function Tests
  • Protein Binding
  • Reference Values
  • Retrospective Studies
  • Time Factors
  • von Willebrand Diseases / blood*
  • von Willebrand Diseases / diagnosis*
  • von Willebrand Diseases / therapy
  • von Willebrand Factor / biosynthesis*

Substances

  • Coagulants
  • Hemostatics
  • von Willebrand Factor
  • Factor VIII
  • Collagen
  • Deamino Arginine Vasopressin