Risk for gastrointestinal bleeding in adult patients with von Willebrand disease (VWD) may be 2.5 times higher compared with adults without VWD, according to results from a retrospective study published in Thrombosis Research. The study included an identification of risk factors.

Prevalence of gastrointestinal bleeding was determined by analyzing National Inpatient Sample (NIS) records of patients who had been hospitalized at community hospitals throughout the United States between 2009 and 2014. The NIS contains information on approximately 7 million inpatient records. There were 16,640 patients with VWD enrolled in this registry.

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Gastrointestinal bleeding occurred in patients with VWD at a rate of 3.7% compared with a rate of 1.48% among patients without VWD (P <.0001).

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The researchers also analyzed risk factors for gastrointestinal bleeding. Multivariate logistic regression analysis showed that multiple risk factors were more common with gastrointestinal bleeding, and risk factors were mostly similar between patients with and without VWD.

In patients with VWD, the strongest risk factors for gastrointestinal bleeding were found to be angiodysplasia (odds ratio [OR], 104.06; 95% CI, 75.14-144.11; P <.0001), diverticulitis (OR, 16.66; 95% CI, 11.85-23.42; P <.0001), and hepatitis C (OR, 2.17; 95% CI, 1.40-3.36; P =.0005). Other risk factors included African-American race (OR, 1.80; 95% CI, 1.31-2.47; P =.0003), male gender (OR, 1.61; 95% CI, 1.30-2.00; P <.0001), and smoking (OR, 1.40; 95% CI, 1.04-1.88; P =.0245). Age appeared to be a statistically significant variable in this analysis but with a weak effect (OR, 1.01; 95% CI, 1.01-1.02; P <.0001).

The study authors stated that the rates of gastrointestinal bleeding among patients with or without VWD in this analysis were consistent with other published results. The authors recommended that patients with VWD may benefit from treatment with factor prophylaxis after experiencing initial gastrointestinal bleeding, in addition to addressing the proximate cause of the gastrointestinal bleeding.


  1. Tsagianni A, Comer DM, Yabes JG, Ragni MV. Von Willebrand disease and gastrointestinal bleeding: a national inpatient sample study [published online April 16, 2019]. Thromb Res. doi:10.1016/j.thromres.2019.04.017