Von Willebrand Disease and ESI

[jwalker12]

Have any of you ever encounted a patient with von willebrand's disease and actually pursued an intervention. Is it worth the risk of trying DDAVP and doing an ESI or would most recommend medication management? Is this a patient that you would be ok giving opioids to should neuropathics fail? Thanks in advance for the help.

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[Taus]

Ok by me as long as their hematologist clears and manages the ddavp

 

[Ducttape]

yes, we have discussed this on other threads.

https://forums.studentdoctor.net/threads/von-willebrands-cervical-esi.1344657/

get hematology consult.

regardless of how treatment goes, "giving opioids" should be a rare event outside of acute pain, postsurgical pain, and palliative (cancer, end of life) pain.. the presence of von Willebrands should not be a proof of need.

 

[Baron Samedi]

Opioids are ineffective for low back pain

 

[deleted875186]

We do labor epidurals on VWB patients. Key is to know what type they are. Same for surgery in VWB patients. DDAVP is an option, but factor concentrate is available. For most type 1 patients with mild disease, DDAVP is appropriate. I don’t think there’s any clear consensus as to what factor activity level is appropriate for neuraxial though for more severe types.

 

[jwalker12]

thanks yall