How I treat von Willebrand disorders in the elderly.

Von Willebrand disease (VWD) is the most common bleeding disorders and especially milder type 1 VWD might not be cared for in specialty clinics. Von Willebrand factor (VWF) levels rise with age, but the rise of these levels do not necessarily correlate with bleeding risk. A recent bleeding history combined with recent labs are important for hemostatic management decision during surgical interventions. Antifibrinolytics appear safe in the elderly population, while DDAVP should be used cautiously. Where needed, factor concentrates present a great treatment option. Acquired von Willebrand syndrome (AVWS) is vastly underrecognized, but likely to surface in the aging, especially in the setting of co-morbidities such as plasma cell dyscrasias. IVIG can be an effective treatment in this scenario, but potentially increases thrombotic risk.