Asociación entre enfermedad de von Willebrand y angiodisplasia: ¿casualidad o causalidad?

Abstract

Association between von Willebrand disease and angiodysplasiaVon Willebrand factor (vWf) is a fundamental multimeric plasma glycoprotein in the coagulation process. Its function is to mediate platelet adhesion and to stabilize circulating factor VIII. A functional or quantitative alteration of vWf gives rise to von Willebrand disease (vWD). The association between vWD and angiodysplasia was described in 1967, but it was only until 2011 that Starke et al demonstrated the in vitro and in vivo role of vWf in angiogenesis. Congenital or acquired vWf deficiency, especially of high molecular weight multimeters, not only favors bleeding, but also contributes to increased angiogenesis in these patients. The treatment should be focused both on the control of the acute episode of gastrointestinal bleeding, with vWf replacement therapy and local endoscopic treatment, as well as on the prevention of the progression of angiodysplasia and future bleeding. There are different published therapeutic approaches using vWf replacement that are not effective in all patients. Recently, angiogenesis inhibitor medications have been used.

Von willebrand disease and gastrointestinal bleeding: case presentation

“…2,5 Von Willebrand disease and angiodysplasia (as a cause of digestive bleeding) have been associated in up to 20% of patients, especially in types 2A and 3, where it is associated with the loss of high molecular weight multimers, with a prevalence of only 6% in the general population. 8,9 In this case the girl had a history of small hematomas in the lower limbs and despite not being a very common symptom, she presented upper digestive bleeding that required admission and compromised her life. It was not possible to associate it with angiodysplasia, the studies carried out by the digestive tract were negative after this he has continued to present spontaneously appearing ecchymosis and hematomas with minimal trauma.…”

Angiodysplasia of the cecum, a threatening bleeding in the elderly

“…La angiodisplasia de colon (AC) fue descrita por vez primera en 1839 por Phillips (1), siendo esta subdiagnosticada hasta la introducción de la técnica angiográfica con la cual se inicia una descripción detallada de esta patología. (8) Al momento no se dispone de datos estadísticos nacionales sobre esta patología; sin embargo, se describe en la literatura regional mexicana que la incidencia de sangrado digestivo bajo (SDB) se ha estimado en una relación de 20.5 / 100.000 habitantes.…”