In adults with mild von Willebrand disease presenting with mild bleeding, what is the initial treatment?

• A. Desmopressin (DDAVP) to release von Willebrand factor; avoid NSAIDs.
• B. Tranexamic acid.
• C. Vitamin K.
• D. Platelet transfusion.

Answer: (A)

Desmopressin (DDAVP) is used because it releases stored von Willebrand factor and factor VIII from the endothelium, rapidly increasing circulating levels and improving platelet adhesion to form a stable clot. In adults with mild von Willebrand disease and mild bleeding, this aligns with a goal of quick, short-term restoration of hemostasis without needing transfusions. The effect typically appears within 30–60 minutes and lasts several hours, making it suitable for minor mucosal bleeding or before procedures.

When using DDAVP, the usual precautions include avoiding NSAIDs, which can worsen bleeding, and watching for hyponatremia from fluid retention—fluid intake is often limited for about a day after dosing. If DDAVP is ineffective, or if a patient has a vWD subtype that responds poorly or risks from DDAVP (for example, some cases of type 2B), an antifibrinolytic such as tranexamic acid may be used as an adjunct or alternative. Vitamin K won’t correct von Willebrand disease, and platelet transfusion is reserved for more serious bleeding or DDAVP-resistant cases, not as initial therapy for a mild bleed.