BACKGROUND: In individuals with borderline von Willebrand factor (VWF) plasma levels, second-level tests are required to confirm or exclude von Willebrand disease (VWD). These tests are time-consuming and expensive. OBJECTIVE: To assess which parameters can predict VWD diagnosis in individuals with borderline VWF levels (30-60IUdL(-1) ). METHODS: Nine hundred and fifty individuals with bleeding episodes or abnormal coagulation test results were investigated with first-level tests (blood count, prothrombin time, activated partial thromboplastin time, blood clotting factorVIII, VWF ristocetin cofactor activity [VWF:RCo], and VWF antigen), and 93 (62 females and 31 males; median age, 28years; interquartile range15-44) had borderline VWF:RCo levels. All underwent second-level investigations to confirm or exclude VWD. A multivariable logistic regression model was fitted with sex, age, bleeding score, family history, VWF:RCo and ABO blood group as predictors, and used to predict VWD diagnosis. RESULTS: Forty-five of the 93 individuals (48%) had VWD (84% type1). A negative linear relationship between VWF:RCo levels and risk of VWD diagnosis was present, and was particularly evident with blood group non-O [adjusted odds ratio7.00 (95% confidence interval [CI]1.48-33.11) for every 5IUdL(-1) decrease in VWF:RCo]. The other variable clearly associated with VWD diagnosis was female sex (adjusted odds ratio5.76 [95%CI1.47-22.53]). The area under the receiver operating characteristic curve of the full logistic model was 0.89 (95%CI0.82-0.95). CONCLUSIONS: In individuals with borderline VWF, the two strongest predictors of VWD diagnosis are low VWF:RCo levels (particularly in those with blood group non-O) and female sex. This predictive model has a promising discriminative ability to identify patients with borderline VWF levels who are likely to have VWD.

Predictors of von Willebrand disease diagnosis in individuals with borderline von Willebrand factor plasma levels / P. Bucciarelli, S.M. Siboni, F. Stufano, E. Biguzzi, M.T. Canciani, L. Baronciani, M.T. Pagliari, S. La Marca, C. Mistretta, F.R. Rosendaal, F. Peyvandi. - In: JOURNAL OF THROMBOSIS AND HAEMOSTASIS. - ISSN 1538-7933. - 13:2(2015 Feb 26), pp. 228-238. [10.1111/jth.12799]

Predictors of von Willebrand disease diagnosis in individuals with borderline von Willebrand factor plasma levels

P. Bucciarelli;L. Baronciani;S. La Marca;C. Mistretta;F. Peyvandi
2015-02-26

Abstract

BACKGROUND: In individuals with borderline von Willebrand factor (VWF) plasma levels, second-level tests are required to confirm or exclude von Willebrand disease (VWD). These tests are time-consuming and expensive. OBJECTIVE: To assess which parameters can predict VWD diagnosis in individuals with borderline VWF levels (30-60IUdL(-1) ). METHODS: Nine hundred and fifty individuals with bleeding episodes or abnormal coagulation test results were investigated with first-level tests (blood count, prothrombin time, activated partial thromboplastin time, blood clotting factorVIII, VWF ristocetin cofactor activity [VWF:RCo], and VWF antigen), and 93 (62 females and 31 males; median age, 28years; interquartile range15-44) had borderline VWF:RCo levels. All underwent second-level investigations to confirm or exclude VWD. A multivariable logistic regression model was fitted with sex, age, bleeding score, family history, VWF:RCo and ABO blood group as predictors, and used to predict VWD diagnosis. RESULTS: Forty-five of the 93 individuals (48%) had VWD (84% type1). A negative linear relationship between VWF:RCo levels and risk of VWD diagnosis was present, and was particularly evident with blood group non-O [adjusted odds ratio7.00 (95% confidence interval [CI]1.48-33.11) for every 5IUdL(-1) decrease in VWF:RCo]. The other variable clearly associated with VWD diagnosis was female sex (adjusted odds ratio5.76 [95%CI1.47-22.53]). The area under the receiver operating characteristic curve of the full logistic model was 0.89 (95%CI0.82-0.95). CONCLUSIONS: In individuals with borderline VWF, the two strongest predictors of VWD diagnosis are low VWF:RCo levels (particularly in those with blood group non-O) and female sex. This predictive model has a promising discriminative ability to identify patients with borderline VWF levels who are likely to have VWD.
ABO blood group system; Bayesian prediction; Blood coagulation; Von willebrand disease; Von willebrand factor
Settore MED/09 - Medicina Interna
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/253359
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