A girl with mild von willebrand disease has a previous history of heavy bleeding during tooth extraction. What is the prophylaxis to be given before tooth extraction?
**Core Concept**
Von Willebrand disease (VWD) is a congenital bleeding disorder characterized by deficiency or dysfunction of von Willebrand factor (VWF), a protein essential for platelet adhesion and coagulation factor VIII stability. Patients with VWD are at increased risk of bleeding complications during invasive procedures, such as tooth extraction.
**Why the Correct Answer is Right**
In patients with VWD, particularly those with mild disease, the goal of prophylaxis is to increase VWF levels and enhance platelet adhesion to prevent excessive bleeding. Desmopressin (DDAVP) is a synthetic analogue of vasopressin that stimulates the release of VWF and factor VIII from endothelial cells. By administering DDAVP 1-2 hours before tooth extraction, VWF levels can be adequately elevated to prevent bleeding complications.
**Why Each Wrong Option is Incorrect**
* **Option A:** Tranexamic acid is an antifibrinolytic agent that inhibits plasminogen activation and fibrinolysis. While it can be used to reduce bleeding in various clinical scenarios, it is not the primary prophylactic agent for VWD.
* **Option B:** Fresh frozen plasma (FFP) contains all coagulation factors, including VWF, but is not the preferred choice for VWD prophylaxis due to its high volume requirement and potential for volume overload.
* **Option D:** Platelet transfusion is not indicated in VWD, as the underlying issue is VWF deficiency, not thrombocytopenia or platelet dysfunction.
**Clinical Pearl / High-Yield Fact**
When managing patients with VWD, it's essential to consider the type and severity of the disease, as well as the patient's previous bleeding history, to determine the most appropriate prophylactic strategy.
**Correct Answer:** C. Desmopressin (DDAVP)