Abstract:
:The increased prevalence of the laboratory diagnosis of von Willebrand disease (vWD) in women presenting with menorrhagia has raised concerns regarding certain specifics in vWD testing in women, including when vWD testing should be done in relation to menses and whether testing should be done while the patient is not taking an oral contraceptive (OC). These concerns have been based on historical reports that vWF and factor (F) VIII:coagulant activity levels can decrease during menses and conceivably increase the probability of diagnosing vWD when the patient is menstruating, whereas hormone therapy can increase the vWF levels and conceivably mask the diagnosis of vWD. Historically, the reports of a decrease in vWF levels during menstruation have been in a relatively small total number of patients; this has not been confirmed in two recent studies. In one study of 95 normal menstruating females sampled serially at days 4 to 7, 11 to 15, and 21 to 28, there was no variation. In another study of 40 volunteers, by cross-sectional analysis there was no difference. However, interestingly in that study, longitudinal analysis of samples showed a decrease in vWF antigen during menstruation. In another recently published study, using cross-sectional analysis, the lowest levels of vWF were found on days 1 through 4, whereas the highest were identified on days 9 through 10. Conceivably, these groups were more finely divided than were those in the other studies. In summary, in light of these conflicting results, recommendations for testing exclusively during menses cannot be made. At this point, it is not unreasonable to suggest that hematologists and gynecologists sample at least once at the time of menstrual bleeding when the diagnosis of vWD in a menstruating female is suspected. Consequently, sampling during the menstrual cycle may likely capture the lowest levels of FVIIIC and vWF antigen. Regarding testing while the patient is taking an OC, present preparations do not contain supraphysiological doses of estrogen and are unlikely to affect the laboratory diagnosis of vWD. These studies primarily have been in controls. Therefore, prospective studies in vWD women of menstrual variation of the vWF levels and the impact of OCs on vWF levels are in order before specific recommendations can be made regarding the timing of testing and whether patients should be tested while the patient is not taking an OC. Other aspects regarding race, age, preanalytical variables, and pregnancy potentially affecting the laboratory diagnosis of vWD are also discussed in this review.
journal_name
Semin Thromb Hemostjournal_title
Seminars in thrombosis and hemostasisauthors
Kouides PAdoi
10.1055/s-2006-947861subject
Has Abstractpub_date
2006-07-01 00:00:00pages
480-4issue
5eissn
0094-6176issn
1098-9064journal_volume
32pub_type
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journal_title:Seminars in thrombosis and hemostasis
pub_type: 杂志文章,评审
doi:10.1055/s-0032-1301413
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journal_title:Seminars in thrombosis and hemostasis
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journal_title:Seminars in thrombosis and hemostasis
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doi:10.1055/s-0035-1544229
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journal_title:Seminars in thrombosis and hemostasis
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doi:10.1055/s-2007-999016
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更新日期:2003-04-01 00:00:00
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journal_title:Seminars in thrombosis and hemostasis
pub_type: 杂志文章,评审
doi:10.1055/s-2007-996094
更新日期:1997-01-01 00:00:00
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更新日期:2010-11-01 00:00:00
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更新日期:2004-12-01 00:00:00
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pub_type: 临床试验,杂志文章
doi:10.1055/s-0035-1564837
更新日期:2016-02-01 00:00:00
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journal_title:Seminars in thrombosis and hemostasis
pub_type: 杂志文章,评审
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更新日期:2006-02-01 00:00:00
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journal_title:Seminars in thrombosis and hemostasis
pub_type: 杂志文章
doi:
更新日期:1993-01-01 00:00:00
abstract::Women with inherited or acquired thrombophilia are at increased risk for venous thromboembolism (VTE) when they use oral contraceptives (OCs) of either the second or third generation. For women who are heterozygous for Factor V Leiden, the risk is probably 28 to 50 of 10,000 women-years compared to 2 to 5 of 10,000 ye...
journal_title:Seminars in thrombosis and hemostasis
pub_type: 杂志文章,评审
doi:
更新日期:1998-01-01 00:00:00
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doi:10.1055/s-0032-1302442
更新日期:2012-04-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2014-09-01 00:00:00
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journal_title:Seminars in thrombosis and hemostasis
pub_type: 杂志文章,评审
doi:10.1055/s-2007-999001
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doi:10.1055/s-2004-831040
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pub_type: 杂志文章,评审
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更新日期:2012-11-01 00:00:00
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journal_title:Seminars in thrombosis and hemostasis
pub_type: 杂志文章
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pub_type: 杂志文章,评审
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更新日期:2010-06-01 00:00:00
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pub_type: 杂志文章,评审
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pub_type: 杂志文章
doi:10.1055/s-2007-995844
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pub_type: 杂志文章,评审
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pub_type: 杂志文章,评审
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更新日期:2014-09-01 00:00:00
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pub_type: 杂志文章,评审
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