Type 1 vWD "mild" - would you guys do CESI on this patient?

[SpineandWine]

Clinical Vignette: 38 M "mild" type I von Willebrand's disease for the past several years and mainly notices recurrent epistaxis for which patient has used topical nasal DDAVP to control. He has required IV DDAVP prior to prior orthopedic procedures.
Labs performed show following: Factor VIII activity 96 (nl range 56-140), vW Ag 71 (50-200), vWF 54 (50-200), PT 10.2 (9.1-11.1), INR 1.0, PTT 26 (20-30).
No blood thinning medications.

Question: Would you do CESI if patient receives IV DDAVP 30 minutes prior to procedure?

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[lobelsteve]

yes

 

[callmeanesthesia]

Yes

 

[willabeast]

I would document discussion with a hematologist before injecting.

 

[Ducttape]

Get heme clearance and do ddavp and then CESI.

I've done it several times.

 

[Ducttape]

Get heme clearance and do ddavp and then CESI.

I've done it several times

 

[SpineandWine]

That's what I figured- thanks everyone!