Abstract
von Willebrand factor (VWF) plays critical roles in initiating primary hemostasis
and extending the half-life of coagulation factor VIII in circulation. VWF levels
increase with age and elevated levels are associated with an increased risk of venous
thromboembolism and cardiovascular disease (CVD). Patients with von Willebrand disease
(VWD) due to a deficiency or dysfunction of VWF may have symptoms that ameliorate
with aging or may have exacerbation of their disease. Bleeding sites of particular
challenge in the aging patient include gastrointestinal bleeding and hematuria. Some
medications used to treat VWD should be used with special precaution in older patients,
including desmopressin and VWF-containing factor concentrates. Patients with VWD may
have some protection from CVD, but in those patients who develop CVD, management is
very challenging, given the role of antiplatelet therapy as the mainstay of treatment.
Keywords
von Willebrand factor - von Willebrand disease - factor VIII - hemorrhage - thrombosis
- aging
