Nathan Connell, MD, MPH, FACP of Brigham and Women’s Hospital, Harvard Medical School speaks about ASH ISTH NHF WFH 2021 guidelines on the management of von Willebrand disease.
Context:
A prevalent hereditary bleeding disorder is von Willebrand disease (VWD). In management options provided to patients, substantial variability occurs.
Target:
The aim of these evidence-based recommendations from the American Society of Hematology (ASH), the International Society on Thrombosis and Haemostasis (ISTH), the National Hemophilia Foundation (NHF), and the World Federation of Hemophilia (WFH) is to help patients, physicians, and health care practitioners in their VWD management decisions.
Methodology:
The multidisciplinary guideline panel was founded by ASH, ISTH, NHF, and WFH. They had three patient members. To eliminate perceived bias from conflicts of interest, the panel was balanced. The Results and Implementation Research Unit of the University of Kansas and the McMaster Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the process of developing guidance, including the implementation and updating of systematic evidence reviews (through November 2019). According to their relevance to physicians and patients, the panel prioritized clinical concerns and findings. The panel used the GRADE methodology to analyze evidence and make recommendations, including GRADE Evidence-to-Decision systems, which were open to public feedback.
Outcomes:
12 recommendations were agreed by the panel and future research goals were outlined.
Findings:
These guidelines make key recommendations about prophylaxis for frequent repeated bleeding, treatment determination studies of desmopressin, use of antiplatelet agents and anticoagulant therapy, target VWF, and factor VIII activity levels for major surgery, bleeding reduction strategies during minor surgery or invasive procedures, severe menstrual bleeding control choices, VWD management in minor surgery or invasive procedures.