What does this research mean for the field?

Intermediate- and low-ratio clotting factor concentrates produce greater initial VWF and FVIII peaks, whereas high-ratio products result in more sustained FVIII elevation in patients with von Willebrand disease undergoing surgery. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the perioperative pharmacokinetics of von Willebrand factor and factor VIII in patients with von Willebrand disease treated with factor concentrates featuring different ratio profiles.

September 2, 2026HaemophiliaOpen Access

Perioperative von Willebrand Factor and Factor VIII Kinetics in von Willebrand Disease Patients Treated With Different Clotting Factor Concentrates

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To evaluate the perioperative pharmacokinetics of von Willebrand factor and factor VIII in patients with von Willebrand disease treated with factor concentrates featuring different ratio profiles.
Single-centre observational study of 123 patients with von Willebrand disease undergoing surgery (63% major surgery) between 2009 and 2024.
Patients received high-ratio (HRP, 10:1; n=24), intermediate-ratio (IRP, 2.4:1; n=61), or low-ratio (LRP, 1:1; n=38) plasma-derived concentrates with a median of three infusions.
Factor kinetics were modeled using linear mixed-effects models alongside assessments of bleeding and venous thromboembolism.
Incremental VWF recoveries were 1.7 IU/dL per IU/kg for HRP, 1.3 for IRP, and 2.4 for LRP, while incremental FVIII recoveries were 2.5 for IRP and 2.7 for LRP.
Over time, HRP yielded higher mean VWF levels than IRP (Δ26 IU/dL; p = 0.010) and higher FVIII levels compared with both IRP (Δ48 IU/dL; p < 0.001) and LRP (Δ35 IU/dL; p = 0.021).
In patients receiving three infusions in 24 hours, FVIII remained higher with HRP than IRP (Δ38 IU/dL; p = 0.019), and no venous thromboembolic events occurred.

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Implication

Observational study reveals distinct clotting factor trajectories with different concentrate ratios in surgical von Willebrand disease, suggesting tailored perioperative dosing is warranted.

Cite This Study

Gras et al. (2026) studied this question.

synapsesocial.com/papers/6a97e29ec562ede874ec6d02 https://doi.org/10.1111/hae.70386

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Implication

Observational study reveals distinct clotting factor trajectories with different concentrate ratios in surgical von Willebrand disease, suggesting tailored perioperative dosing is warranted.

Perioperative von Willebrand Factor and Factor VIII Kinetics in von Willebrand Disease Patients Treated With Different Clotting Factor Concentrates

Key Points

Discussion

Implication

Cite This Study

Perioperative von Willebrand Factor and Factor VIII Kinetics in von Willebrand Disease Patients Treated With Different Clotting Factor Concentrates

Key Points

Discussion

Implication

Cite This Study

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