The relatively high prevalence of subnormal von Willebrand factor levels in menorrhagia

Kouides, Peter A.; Phatak, PD; Sham, Ronald L.; Braggins, Caroline; Cox, Conrad B.; Howard, Frank M.

doi:10.1016/s0029-7844(99)90141-2

Cited by 4 publications

(8 citation statements)

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“…Twelve studies were identified 11–22 . Five 14–16,20,22 of these were published as abstracts from Congress proceedings and we were able to contact the authors of one abstract 15 . The abstract included results from preliminary data and after contacting the authors we were given data from the completed studies.…”

Section: Resultsmentioning

confidence: 99%

“…Tables 1 and 2 present details of the studies reviewed. Four studies 11–13,15 tested two or more samples before diagnosis was made, while four studies 11,12,15,19 tested only once in the first week of the menstrual cycle.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 988 women were involved in the 11 studies and 131 were diagnosed as having von Willebrand disease, with prevalence in the individual studies ranging from 5% to 24% 11–22 . The prevalence rates with confidence intervals are given in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…All studies reported prevalences that were higher than in the general population. Only three 15,17,18 studies used controls for comparison while all other studies used general population prevalence quoted in the literature 9,10 …”

Section: Resultsmentioning

confidence: 99%

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von Willebrand disease in women with menorrhagia: a systematic review

Shankar

Lee

Sabin

et al. 2004

BJOG

246

170

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Objective To determine the prevalence of von Willebrand disease in women presenting with menorrhagia.Design Systematic review of studies evaluating the prevalence of von Willebrand disease in women with menorrhagia. Setting Hospital outpatient clinics (mainly gynaecological) and population surveys.Population Women presenting with menorrhagia.Methods Relevant studies were extracted from MEDLINE search, bibliographies of identified articles and published proceedings of meetings and conferences. Main outcome measures Number of women with von Willebrand disease.Results Eleven studies were included, totalling 988 women with menorrhagia. One hundred and thirty-one women were diagnosed to have von Willebrand disease with prevalences in individual studies ranging from 5% to 24%. The overall prevalence was 13% (95% CI 11-15.6%). The prevalence was higher in the European studies-18% (95% CI 15 -23%) compared with that in North American studies-10% (95% CI 7.5 -13%). This difference (P ¼ 0.007) is likely to be the result of differences in the studies, which include method of recruitment of study population, method of assessing menstrual blood loss ethnic composition of study population, criteria for diagnosis and use of race-and ABO blood group-specific values for von Willebrand factor. Conclusions The prevalence of von Willebrand disease is increased in women with menorrhagia and is the underlying cause in a small but significant group of women with menorrhagia across the world. Testing for this disorder should be considered when investigating women with menorrhagia, especially those of Caucasian origin, those with no obvious pelvic pathology or with additional bleeding symptoms.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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von Willebrand disease in women with menorrhagia: a systematic review

Shankar

Lee

Sabin

et al. 2004

BJOG

246

170

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“…As every third girl presenting with menorrhagia has subnormal VWF levels, particularly if tested during menses and if the blood group is O ( Kouides et al , 1998 ), treatment with intranasal/subcutaneous DDAVP, which can be readily administered at home, is very attractive. Issues remain regarding the optimal dose/schedule and the relative efficacy of antifibrinolytic agents.…”

Section: Haemostatic Response To Ddavp Therapymentioning

confidence: 99%

Ddavp Is Not a Panacea for Children With Bleeding Disorders

Sutor

2000

Br J Haematol

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Epidemiology, Diagnosis, and Management ofvon Willebrand Disease in India

Ghosh¹,

Shetty²

2011

Semin Thromb Hemost

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Von Willebrand disease (VWD) in all developing countries including India is considered a rare coagulation disorder, contrary to many reports from Western countries. Prevalence data based on hospital referrals identifies type 3 VWD as the most common subtype followed by type 1 and type 2. Approximately 60 to 70% cases of type 3 VWD are reportedly born of consanguineous marriages. The discriminatory diagnostic tests mainly include assays for factor (F)VIII:C and ristocetin-induced platelet agglutination and Von Willebrand factor (VWF) antigen either by immunoelectrophoresis or by enzyme-linked immunosorbent assay. VWD-type assisting tests like VWF collagen binding, VWF ristocetin cofactor assay, VWF-FVIII binding assay, and multimer analysis are occasionally used but not routinely applied in many laboratories. Among women, menorrhagia is an important presenting manifestation. Except for a handful of centers mainly in metropolitan cities, most laboratories in the remote parts of the country have no facilities for VWD-related investigations, resulting in occasional misdiagnoses of VWD as hemophilia A. Genetic diagnosis is being offered in two or three centers using the indirect linkage method in type 3 VWD, and efforts are continuing to implementing a direct mutation detection technique for routine practice in a few laboratories. Depending on the subtype or the severity of VWD, desmopressin, cryoprecipitate, fresh-frozen plasma, and factor VIII/VWF concentrates are used for management. Antifibrinolytic agents like epsilon-aminocaproic acid and tranexamic acid are widely used as an adjuvant therapy. In women with menorrhagia, oral contraceptives as a supplementary treatment are also being widely advocated to reduce bleeding. Products like danazol, ethenyl estradiol, thalidomide, and atorvastatin have been used in individual patients; acquired VWD associated with hypothyroidism has been managed successfully with thyroid hormone treatment. Both minor and major surgical procedures are performed in a few centers with judicious use of cryoprecipitate or FVIII concentrate containing VWF along with other supplementary therapeutic products to achieve adequate hemostasis. Awareness about the disease, establishment of the comprehensive coagulation laboratory, and treatment centers will be successful in increasing diagnosis of VWD and consequently better management of affected patients. This is likely to tilt the ratios of different VWD types, and VWD is likely to emerge as the most common of all coagulation disorders in the near future.

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The relatively high prevalence of subnormal von Willebrand factor levels in menorrhagia

Cited by 4 publications

References 0 publications

von Willebrand disease in women with menorrhagia: a systematic review

von Willebrand disease in women with menorrhagia: a systematic review

Ddavp Is Not a Panacea for Children With Bleeding Disorders

Epidemiology, Diagnosis, and Management ofvon Willebrand Disease in India

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