What is the mainstay of therapy for von Willebrand disease?

• A. Desmopressin
• B. Vitamin K
• C. Platelet transfusion
• D. Factor VIII concentrate

Answer: (A)

Desmopressin works as the mainstay because it stimulates the body's own release of von Willebrand factor stored in endothelial cells, which also raises factor VIII levels. This transient boost improves platelet adhesion to damaged vessels and helps stabilize clots, making it effective for many patients with mild to moderate von Willebrand disease and for preventing or treating bleeding around minor procedures. It’s particularly useful in type 1 vWD and some type 2 variants.

However, not all forms respond. In type 3 disease there’s essentially no vWF to release, so desmopressin is unlikely to help and replacement with vWF-containing concentrates is needed. Some type 2 variants, especially type 2B, may be less responsive or have adverse effects, limiting its use. Vitamin K does not address vWF deficiency, so it isn’t a treatment for this condition. Platelet transfusion is reserved for severe, acute bleeds or when DDAVP fails, and factor VIII/vWF concentrates serve as alternative replacements when desmopressin isn’t suitable or rapid correction is required.