Von Willebrand Disease in Older Patients: A Retrospective Electronic Health Record Review

Abstract

Von Willebrand disease (VWD) is often diagnosed as a consequence of symptoms experienced with hemostatic stressors, such as menstruation and childbirth. Thus, patients seeking medical care for VWD are generally younger. As a result, the natural course of VWD in older adults has not been well described. A retrospective electronic health record review was performed to provide a descriptive analysis of older VWD patients with at least one clinic visit at the Hemophilia Center of Western Pennsylvania (HCWP) between June 1, 2015, and May 31, 2021, and age 45 or older at the time of the visit. Data collected included VWD-related information, multimorbidity, and medications. Age-related change in von Willebrand factor (VWF) levels and the influence of multimorbidity on VWF levels were assessed. Seventy patients had 131 HCWP clinic visits. Hypertension, 34.3%, and osteoarthritis, 32.3%, were the most common multimorbidity-associated conditions. More than 33% of patients were receiving at least one antihemostatic medication. The most common bleeding symptom was ecchymosis, 22.9%. VWF antigen levels, 0.76 IU/mL, and the proportion of patients with normal VWF levels, 54.5%, increased with age to 0.99 IU/mL, p < 0.001, and 78.8%, p < 0.001, respectively. Multimorbidity did not predict change in VWF levels, p = 0.84. Of 62 invasive procedures performed, bleeding occurred in one of nine where VWD-specific therapy was omitted. These findings underscore the importance of describing the natural course of VWD in older adults, especially the critical nature of determining bleeding risk to guide clinical decision-making with the use of antihemostatic drugs and periprocedural VWD-specific therapy.