IV Individualized dose. VWF & FVIII are present in a ratio of 2:1.
VWD population Spontaneous bleeding episodes Initially 12.5-25 IU FVIII:C/kg, equivalent to 25-50 IU VWF:Ac/kg (target peak level: FVIII >30%, VWF >50%). Subsequently 12.5 IU FVIII:C/kg (= 25 IU VWF:Ac/kg) every 12-24 hr until bleeding stops (target trough FVIII/VWF level >30%).
Minor surgery 30 IU FVIII:C/kg (= 60 IU VWF:Ac/kg) daily until healing is complete (target trough FVIII/VWF level >30%).
Major surgery Initially 30-40 IU FVIII:C/kg (= 60-80 IU VWF:Ac/kg) (target peak level: FVIII >60%, VWF >100%). Subsequently 15-30 IU FVIII:C/kg (= 30-60 IU VWF:Ac/kg) every 12-24 hr until healing is complete (target trough FVIII/VWF level >50%).
Prophylaxis 12.5-20 FVIII:C/kg (= 25-40 IU VWF:Ac/kg) 1-3 times wkly (target trough FVIII/VWF >1%).
VWD paed patients <12 yr Prophylaxis 40-80 IU VWF:Ac/kg 1-3 times wkly.
Haemophilia A population Minor bleeding episodes 10-15 IU/kg 12-24 hrly for 1-2 days (target peak FVIII 20-30%).
Moderate to severe bleeding episodes eg, haemarthroses 15-40 IU/kg 8-24 hrly for 1-4 days (target peak FVIII 30-80%).
Life-threatening bleeding eg, intracranial haemorrhage Day 1: Single dose of 50-60 IU/kg (target peak FVIII >100%). Days 2-10: 20-25 IU/kg 8-12 hrly (target trough FVIII 80-100%).
Minor surgery Pre-op: Single dose of 20-30 IU/kg (target peak FVIII 40-60%). Days 1-3: 20-25 IU/kg 12 hrly (target trough FVIII 40-50%). Day 4 onwards: 20-30 IU/kg 24 hrly (target trough FVIII 20-30%).
Major surgery Pre-op: Single dose of 40-50 IU/kg (target peak FVIII 80-100%). Days 1-3: 20-25 IU/kg 8-12 hrly (target trough FVIII 80-100%). Days 4-6: 15-20 IU/kg 8-12 hrly (target trough FVIII 60-80%). Day 7 onwards: 10-20 IU/kg 12 hrly (target trough FVIII 40-60%).
Dentistry eg, invasive dental procedures, extractions, surgery Pre-op: Single dose of 35-40 IU/kg (target peak FVIII 70-80%). Days 1-3: 25-30 IU/kg 12 hrly (target trough FVIII 50-60%).
Prophylaxis 25-40 IU/kg 3 times wkly (target trough FVIII 1%).