A patient with von Willebrand disease undergoing surgery would be treated with replacement therapy including von Willebrand factor and which coagulation factor?

• A. Thrombin
• B. Factor VI
• C. Factor VII
• D. Factor VIII

Answer: (D)

Replacement therapy for von Willebrand disease during surgery targets both VWF function and the level of Factor VIII because VWF stabilizes FVIII in circulation. Von Willebrand factor binds to FVIII and protects it from rapid degradation, extending its half-life. When VWF is deficient, FVIII levels can drop, reducing thrombin generation via the intrinsic pathway and impairing clot formation. To ensure reliable hemostasis, VWF-containing concentrates given for surgery are paired with Factor VIII, so FVIII activity remains sufficient. That’s why Factor VIII is the coagulation factor used with VWF replacement.

Other options don’t address this stabilization role: thrombin acts further downstream and isn’t given as a replacement in VWD; Factor VII would influence the extrinsic pathway but doesn’t compensate for VWF-related FVIII deficiency; Factor VI isn’t used clinically.