Although modern hemostatic assays have proven to be useful at helping to limit patient morbidity and mortality in emergency settings, assessing bleeding risks in patients with clinically relevant von Willebrand disease (VWD) has been difficult. However, a recent study demonstrated a rotational thromboelastometry (ROTEM)-based approach that may allow sensitive assessment of clinically relevant VWD, with results published in BMC Anesthesiology.

The prospective single-center cohort study included 27 patients suspected of having VWD. The researchers tracked patterns of clot formation and strength using ROTEM-based coagulation analysis in whole blood samples after consecutive additions of ristocetin and von Willebrand factor (VWF).

After the ROTEM-based analyses were conducted, 5 patients were identified as showing normal coagulation activity, 2 of whom had seemingly mild type I VWD. Another 7 patients, all of whom had VWD, showed a strong response (P <.0001) to VWF. A total of 15 patients, 10 of whom were judged to have VWD or suspected VWD, showed a low or heterogeneous response (P <.001).

For a ristocetin-treated blood sample of 1 patient found to have type 3 VWD, supplementation with VWF resulted in a coagulation pattern that resembled that of a healthy control. This result led the authors to propose VWF treatment as a ROTEM-guided solution to acute bleeding in patients with similar assay results.

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The study authors concluded that the ROTEM-based assay in the presence of ristocetin could help screen patients for clinically relevant VWD. Furthermore, addition of VWF to the assay could help to quickly determine the appropriateness of VWF supplementation in a setting of critical bleeding. Hemostatic therapies to combat excessive bleeding could obviate usage of blood transfusions, noted the authors.

Reference

1. Topf HG, Strasser ER, Breuer G, Rascher W, Rauh M, Fahlbusch FB. Closing the gap – detection of clinically relevant von Willebrand disease in emergency settings through an improved algorithm based on rotational thromboelastometry [published online January 10, 2019]. BMC Anesthesiol. doi:  10.1186/s12871-018-0672-8