Table 9.3-2. Typical doses of factor VIII concentrate containing von Willebrand factor (vWF) in the prevention and treatment of bleeding in patients with severe vWF and factor VIII deficiency (<10%)

Type of bleeding

Dose (IU/kg)a

Frequency of administration

Suggested plasma activity of factor VIII or vWF (% of normal)

Major surgeryb

50

Before procedure, then every 12-24 h until wound is completely healed

>50% for 5-7 days, then dose may be reduced

Minor surgery

40

Before procedure, then every 24-48 h until wound is completely healed

>30% for 1-5 days

Tooth extractionc

30

Once before procedure

>50% for 12 h

Minor bleeding

25

Repeat every 24 h if necessary

>30% until bleeding stops

Delivery

40

Every 24 h

>50% on day of delivery and for subsequent 3-4 days

a In children increase each dose by 20% because of the higher relative plasma volume.

b In patients with severe bleeding (eg, central nervous system hemorrhage) use the same doses as for major surgery. To reduce the risk of thrombosis, maintain plasma factor VIII activity <250% of normal.

c For 3 to 7 days after the extraction, additionally administer tranexamic acid 10 to 15 mg/kg orally every 8 hours.