Treatment

Even though von Willebrand disease has no cure, treatment can help prevent or stop bleeding episodes. Your treatment depends on:

• The type and severity of your condition
• How you've responded to previous therapy
• Your other medications and conditions

Your doctor might suggest one or more of the following treatments to increase your von Willebrand factor, strengthen blood clots or, in women, control heavy menstrual bleeding:

• Desmopressin. This medication is available as an injection (DDAVP) or nasal spray (Minirin) It's a synthetic hormone that controls bleeding by stimulating your body to release more of the von Willebrand factor stored in the lining of your blood vessels.

  Many doctors consider DDAVP the first treatment for managing von Willebrand disease. Some women use the nasal spray at the beginning of their menstrual periods to control excessive bleeding. It can also be effective when used before a minor surgical procedure.

• Replacement therapies. These include infusions of concentrated blood-clotting factors containing von Willebrand factor and factor VIII. Your doctor might recommend them if DDAVP isn't an option for you or was ineffective.

  Another replacement therapy approved by the FDA for treating adults 18 and older is a genetically engineered (recombinant) von Willebrand factor product. Because recombinant factor is made without plasma, it can reduce the risk of a viral infection or allergic reaction.

• Oral contraceptives. For women, these can be useful for controlling heavy bleeding during menstrual periods. The estrogen hormones in birth control pills can boost von Willebrand factor and factor VIII activity. This effect is likely available with birth control patches, though further study is needed to confirm it.
• Clot-stabilizing medications. These anti-fibrinolytic medications — such as aminocaproic acid (Amicar) and tranexamic acid (Cyklokapron, Lysteda) — can help stop bleeding by slowing the breakdown of blood clots. Doctors often prescribe these drugs before or after a surgical procedure or tooth extraction.
• Drugs applied to cuts. A fibrin sealant (Tisseel VHSD) placed on a cut helps curtail bleeding. This is applied like glue using a syringe. There are also over-the-counter products to stop nosebleeds.

If your condition is mild, your doctor might recommend treatment only when you're having surgery or dental work or when you've had a trauma, such as a car accident.