BACKGROUND: Acquired von Willebrand disease (aVWD) can lead to a propensity to bleed, and many different modalities have been used to treat this condition. The efficacy of these agents in patients with aVWD secondary to cardiac assist devices is not fully understood. STUDY DESIGN AND METHODS: A case is reported of a patient with two risk factors for aVWD, multiple myeloma and ventricular assist device (VAD), who was successfully treated with von Willebrand factor (VWF)/Factor VIII concentrate (Humate-P, CSL Behring) during the bridge to VAD replacement. RESULTS: Although continued absence of high-molecular-weight VWF persisted after VWF replacement with Humate-P, the patient's VWF antigen and activity increased and clinical hemostasis was achieved. The VAD clotted on a few occasions, despite a continuous heparin infusion; however, these events were resolved with temporarily holding the Humate-P. A VAD exchange was performed and the patient was successfully bridged to heart transplant. CONCLUSION: The treatment of VAD-associated aVWD may be augmented with Humate-P, and successful treatment can allow a bridge to heart transplantation. However, careful monitoring for thrombosis in the VAD circuit must be undertaken.
BACKGROUND: Acquired von Willebrand disease (aVWD) can lead to a propensity to bleed, and many different modalities have been used to treat this condition. The efficacy of these agents in patients with aVWD secondary to cardiac assist devices is not fully understood. STUDY DESIGN AND METHODS: A case is reported of a patient with two risk factors for aVWD, multiple myeloma and ventricular assist device (VAD), who was successfully treated with von Willebrand factor (VWF)/Factor VIII concentrate (Humate-P, CSL Behring) during the bridge to VAD replacement. RESULTS: Although continued absence of high-molecular-weight VWF persisted after VWF replacement with Humate-P, the patient's VWF antigen and activity increased and clinical hemostasis was achieved. The VAD clotted on a few occasions, despite a continuous heparin infusion; however, these events were resolved with temporarily holding the Humate-P. A VAD exchange was performed and the patient was successfully bridged to heart transplant. CONCLUSION: The treatment of VAD-associated aVWD may be augmented with Humate-P, and successful treatment can allow a bridge to heart transplantation. However, careful monitoring for thrombosis in the VAD circuit must be undertaken.
Authors: Davor Milicic; Binyamin Ben Avraham; Ovidiu Chioncel; Yaron D Barac; Eva Goncalvesova; Avishai Grupper; Johann Altenberger; Maria Frigeiro; Arsen Ristic; Nicolaas De Jonge; Steven Tsui; Jacob Lavee; Giuseppe Rosano; Marisa Generosa Crespo-Leiro; Andrew J S Coats; Petar Seferovic; Frank Ruschitzka; Marco Metra; Stefan Anker; Gerasimos Filippatos; Stamatis Adamopoulos; Miriam Abuhazira; Jeremy Elliston; Israel Gotsman; Righab Hamdan; Yoav Hammer; Tal Hasin; Lorrena Hill; Osnat Itzhaki Ben Zadok; Wilfried Mullens; Sanemn Nalbantgil; Massimo Francesco Piepoli; Piotr Ponikowski; Luciano Potena; Arjang Ruhparwar; Aviv Shaul; Laurens F Tops; Stephan Winnik; Tiny Jaarsma; Finn Gustafsson; Tuvia Ben Gal Journal: ESC Heart Fail Date: 2021-09-14