DDAVP Von Willebrand Disease — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementDDAVP Von Willebrand DiseaseORE Part 1

A patient with type 1 von Willebrand disease requires a simple dental extraction. Their haematology team confirms a previous satisfactory response to desmopressin and no contraindication to its use. Which peri-operative haemostatic adjunct is most appropriate?

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Correct answer: E — Administer desmopressin before extraction

Explanation lettering: E = shown as A · D = shown as C · C = shown as D · A = shown as E

A is correct. In type 1 von Willebrand disease, desmopressin can be used for haemostatic cover before minor surgery or dental treatment when a satisfactory individual response has been established and the haematology team has advised its use. It raises endogenous von Willebrand factor and factor VIII. Extraction should also employ appropriate local measures, with tranexamic acid considered according to the patient-specific plan. Heparin and warfarin impair coagulation, while aspirin impairs platelet function; none is a haemostatic adjunct for an extraction in a patient with a bleeding disorder. Proceeding without haemostatic planning is inappropriate because patients with von Willebrand disease require specialist advice before dental procedures, even though the eventual regimen must be individualised.

Reference: NHS. Von Willebrand disease, Treatments for von Willebrand disease and Getting specialist advice. Last reviewed 08 April 2024. https://www.nhs.uk/conditions/von-willebrand-disease/?ContensisTextOnly=true