FlashcardsMedical conditions: Bleeding & blood

Von Willebrand disease flashcards

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How does Von Willebrand disease affect dental management?

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How does Von Willebrand disease affect dental management?

Before invasive care: Consult hematology before invasive procedures; the type determines the plan
DDAVP may be useful in responsive type 1 disease; confirm the hematology plan and response. It is ineffective in type 3 and generally contraindicated in type 2B because it can worsen thrombocytopenia.
Factor support: vWF-containing factor concentrates for severe disease or DDAVP nonresponders
Antifibrinolytics: Antifibrinolytics (tranexamic acid or aminocaproic acid) for mucosal procedures
Local measures: atraumatic technique, sutures, gelatin sponge or oxidized cellulose, pressure
Nerve blocks: ask hematology; infiltration and intraligamentary injections carry less risk
Analgesia: Avoid aspirin and NSAIDs; use acetaminophen

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VWD pattern	DDAVP/procedural implication
Responsive type 1	DDAVP may help after hematology confirms response and a suitable procedure.
Type 2B	Generally contraindicated: may worsen thrombocytopenia.
Type 3	Ineffective: near-absent VWF; hematology selects concentrate support.
Type 1C during surgery; age under two; seizure disorder or active cardiovascular disease	Generally contraindicated; choose another hematology-directed plan.
Selected mild type 1, VWF activity > 0.30 IU/mL, minor mucosal procedure	Tranexamic acid alone is a conditional, very-low-certainty option; not blanket extraction clearance.