Obesity is a worseningproblem in the hemophilia patient community, as it is in the population at large, with obesity rates tripling from 1980 to 2008 among all children, according to the Centers for Disease Control and Prevention. Making them aware will allow them to act quickly if you have an injury. Blood Advances. Eur J Obstet Gynecol Reprod Biol 2011;158:12434. Initial screening for an underlying disorder of hemostasis in patients with excessive menstrual bleeding should be structured by the medical history. Am J Obstet Gynecol 2009;201:12.e112.e8. What Causes Thrombotic Thrombocytopenic Purpura? Von Willebrand disease (VWD) is a common inherited condition that can make you bleed more easily than normal. These challenges may include: Limited information about the disease and treatment. 580. Consider using a medical center that specializes in high-risk obstetrics and has a hematologist on staff for prenatal care and delivery. The link to von willebrand disease foods to avoid may be a bit more than just a nosebleed. This site complies with the HONcode standard for trustworthy health information: verify here. Obstet Gynecol Surv 2006;61:13645. Normally, pieces of blood cells (platelets) clump together after an injury. https://rarediseases.org/rare-diseases/von-willebrand-disease/. Before you have any invasive procedure, such as amniocentesis (AM-ne-o-sen-TE-sis), discuss with your doctor whether you need to take steps to prevent serious blood loss. [, Kouides PA, Byams VR, Philipp CS, Stein SF, Heit JA, Lukes AS, et al. Type 1 is the most common type of von Willebrand disease. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Blood. It does not provide medical advice, diagnosis or treatment. You will be subject to the destination website's privacy policy when you follow the link. Takeaway. Committee Opinion No. Talk to specialists before pregnancy. Von Willebrand disease: Treatment of major bleeding and major surgery. If you have von Willebrand disease (VWD), you can take steps to prevent bleeding and stay healthy. One of these proteins is called von Willebrand factor (VWF). They also are likely to have heavy bleeding for an extended time after delivery. Accessed Aug. 26, 2021. Another replacement therapy approved by the Food and Drug Administration for treating adults 18 and older is a genetically engineered (recombinant) von Willebrand factor product. Studies in women without bleeding disorders demonstrate that tranexamic acid reduces menstrual bleeding by 3055% in women with heavy menstrual bleeding 28 29. Dogs with vWD may show signs of bleeding, such as skin bruising, bleeding from the gums or nose . Furthermore, although certain types of von Willebrand disease may be easily distinguished from other bleeding conditions on the basis of laboratory testing, not all types are as straightforward to diagnose. If you have von Willebrand disease (VWD), you can take steps to prevent bleeding and stay healthy. von Willebrand disease overview. The usual cause of von Willebrand disease is an inherited abnormal gene that controls von Willebrand factor a protein that plays a key role in blood clotting. Are treatment options available to reduce that risk? Available at: Diagnosis of abnormal uterine bleeding in reproductive aged women. Have you had anemia or needed a blood transfusion? Boil a handful of crushed fenugreek seeds in water for a couple of minutes before straining the liquid and applying it to your skin using a cotton pad or sponge. One of the most common ways to prevent it is through food. Avoid contact sports like football, hockey and wrestling. Accessed Aug. 26, 2021. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The term "anesthesia" refers to a loss of feeling and awareness. It's a synthetic hormone that controls bleeding by stimulating your body to release more of the von Willebrand factor stored in the lining of your blood vessels. Once a diagnosis of von Willebrand disease has been established, a multidisciplinary approach to management, which involves obstetriciangynecologists and hematologists, results in optimal treatment outcomes 14. This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. Salt Lake City, Utah 84106. If you have the gene for von Willebrand disease, you have a 50% chance of transmitting this gene to your children. Blood in your urine or stool. Physical examination findings that may suggest a bleeding disorder include petechiae, ecchymoses, or other evidence of recent bleeding, although absence of these signs does not exclude the possibility of an underlying bleeding condition 7. In many women, vWF levels increase in pregnancy and, thus, bleeding risk may be lower than it is when a woman is not pregnant. [, Shaaban MM, Zakherah MS, El-Nashar SA, Sayed GH. What are the Signs and Symptoms of Hemochromatosis? Type 2 VWD: VWF is often in the low or low . So you might need to repeat some tests. Description. Von Willebrand disease is a bleeding disorder that slows the blood clotting process. This Committee Opinion addresses long-term management of heavy menstrual bleeding in women with bleeding disorders. Obstet Gynecol 2013;122:136873. After testing for Hemophilia, adults are advised to shift to natural or organic healthy fat products like nonfat milk or low-fat cheese because these are rich in vitamins, minerals, and calcium. In fact, the link may not be due to a nosebleed at all. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. Patients with mild VWD symptoms are rarely diagnosed resulting in the gap "100 to 10 000"[2]. [, James AH, Kouides PA, Abdul-Kadir R, Dietrich JE, Edlund M, Federici AB, et al. All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. You also should meet with an anesthesiologist to review your choices for anesthesia (AN-es-THE-ze-ah) and to discuss taking medicine to reduce your bleeding risk. Von Willebrand disease is the most common inherited bleeding disorder among American women, with a prevalence of 0.6-1.3% 1.The overall prevalence is even greater among women with chronic heavy menstrual bleeding, and ranges from 5% to 24% 2 3.Among women with heavy menstrual bleeding, von Willebrand disease appears to be more prevalent among Caucasians (15.9%) than African Americans (1.3%) 3 4. Von Willebrand disease is the most common bleeding disorder, and affects males and females . The diagnosis, evaluation, and management of von Willebrand disease. Am J Obstet Gynecol 2008;198:163.e1163.e8. blood in the stool from bleeding into the stomach or intestines. Take a family member or friend along, if possible, to help you remember the information you'll be given. https://www.uptodate.com/contents/search. [, Philipp CS, Faiz A, Dowling NF, Beckman M, Owens S, Ayers C, et al. NIH Publication No. Do I need to avoid certain physical activities or types of exercise? Many people with von Willebrand disease don't know it because the signs are mild or absent. [, Obstetric analgesia and anesthesia. Taking charge of your health when you have hemophilia is of great importance. Rarely, the disease skips generations. Bleeding disorders (including hemophilia) are rare. Diagnosing Thrombocythemia and Thrombocytosis, Signs, Symptoms, and Complications of Thrombocythemia and Thrombocytosis, Living with Thrombocythemia and Thrombocytosis, Treatment of Thrombocythemia and Thrombocytosis, Screening and Prevention of Thrombocytopenia, Signs, Symptoms, and Complications of Thrombocytopenia, Other Names for Thrombotic Thrombocytopenic Purpura. Programs like Choose my Plate can help inadopting a healthy eating style. Accessed Aug. 26, 2021. The study found that people who suffered from volebrand disease were more likely to have a stroke at any given time.The studies on volebrand disease foods have been done.A link to von willebrand disease foods to avoid is not a nosebleed. Blood. | Terms and Conditions of Use. Combining iron-rich foods with good sources of vitamin C (such as orange juice) can enhance iron absorption by the body. Clin Exp Obstet Gynecol 2008;35:5760. What are the possible side effects of the medications you're prescribing? VON WILLEBRAND DISEASE, TYPE II B. BJOG 2004;111:14258. In a practical sense, this means I bleed, bruise and injure easily, and those injuries take longer to heal than a person with normal factor levels. Contraception 2011;83:4854. How often do you change your tampon or sanitary pad during a period? Von Willebrand disease (VWD) is an inherited condition that affects males and females. Some safe physical activities are swimming, biking, and walking. [. Theoretically, tranexamic acid also should work in women with von Willebrand disease because it stabilizes clots that have already formed, and clot formation is an essential step in limiting menstrual bleeding. Type 1. These guidelines for diagnosis and management of von Willebrand disease (VWD) were developed for practicing primary care and specialist cliniciansincluding family physicians, internists, obstetrician-gynecologists, pediatricians, and nurse-practitionersas well as hematologists and laboratory medicine specialists. Unlike hemophilia, VWD affects males and females equally. https://www.uptodate.com/contents/search. ABSTRACT: Von Willebrand disease, the most common inherited bleeding disorder among American women, is a common cause of heavy menstrual bleeding and other bleeding problems in women and adolescent girls. Mayo Clinic does not endorse companies or products. How can I best manage them together? How is Disseminated Intravascular Coagulation Diagnosed? Type 1 VWD: VWF are lower than normal (<30%). Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The condition appears in many breeds of dogs, but it . von Willebrand disease in women with menorrhagia: a systematic review. Its a brain bleed. What are the Risk Factors with Thrombotic Thrombocytopenic Purpura? Because von Willebrand disease can be transmitted as an autosomal dominant or recessive trait, the fetus can have up to a 50% risk of being affected. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Screening and Prevention of Thrombotic Thrombocytopenic Purpura, Signs, Symptoms, and Complications of Thrombotic Thrombocytopenic Purpura, Diagnosing Thrombotic Thrombocytopenic Purpura, Treatment of Thrombotic Thrombocytopenic Purpura, Living with Thrombotic Thrombocytopenic Purpura, Signs, Symptoms, and Complications of Von Willebrand Disease, Your Rights and Protections Against Surprise Medical Bills. Have you had bleeding from a small wound that lasted more than 15 minutes or recurred during the week following the wound? Suite 700 The platelet function analyzer-100 closure time can be a useful adjunct in screening for disorders of platelet aggregation, but it lacks sensitivity and specificity to be used alone as a screening test 13. Given emerging controversy surrounding von Willebrand disease testing, consultation with a hematologist may be helpful for the management of patients already taking combined hormonal contraceptives. 2 People with a bleeding disorder often experience the effects of obesity immediately, as excess weight can limit joint mobility and may lead to more frequent joint . Accessed Aug. 26, 2021. Do you have flooding? Since your parents, brothers and sisters, and children may also have von 3 W Garden St People with VWD have a problem with a protein in . https://www.uptodate.com/contents/search. Because of the prevalence of von Willebrand disease as well as other inherited and acquired disorders of coagulation and hemostasis in women who seek evaluation for heavy menstrual bleeding, these conditions should be considered in the differential diagnosis of all women who are evaluated for heavy menstrual bleeding, regardless of age 8. Combining iron-rich foods with good sources of vitamin C (such as . Diet Exercise Travel Emotional Health Pain Management. What are the Signs and Symptoms of Aplastic Anemia? : CD000249. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Multisite management study of menorrhagia with abnormal laboratory haemostasis: a prospective crossover study of intranasal desmopressin and oral tranexamic acid. 1 in 100 to 10 000 individuals is estimated to have VWD. living with von Willebrand disease may mean they should: Avoid activities where they may get hurt, like contact sports such as football . . Von Willebrand disease. ET), James AH. Accessed Aug. 26, 2021. Always check with your doctor before taking any medicines. Who is at Risk for Immune Thrombocytopenia? Procedures, such as fetal scalp electrode or fetal scalp sampling, are better avoided, and circumcision should be postponed until the newborns vWD status is determined 2. The use of levonorgestrel-releasing intrauterine system for treatment of menorrhagia in women with inherited bleeding disorders. [. Do you miss school because of your period? Von Willebrand disease (VWD) is an inherited disorder that affects the blood's ability to clot. What Causes Disseminated Intravascular Coagulation? Affected women may have heavy menstrual bleeding. Individuals who live with a rare disease can face challenges that can be overwhelming. Signs, Symptoms, and Complications of Pulmonary Embolism, Signs and Symptoms of Sickle Cell Disease, Screening and Prevention of Sickle Cell Disease, Signs, Symptoms, and Complications of Thalassemias, Other Names for Thrombocythemia and Thrombocytosis. For example, the school nurse, teacher, daycare provider, coach, or any leader of afterschool activities should know, especially if your child has severe VWD. See Figure 1 for laboratory tests for suspected bleeding disorders. Obesity is a worseningproblem in the hemophilia patient community, https://www.youtube.com/watch?v=F1E6yMXv-1U, Most hemophilia A children were bleed-free after a year on Altuviiio, Remembering when my first child had surgery to get a port-a-cath, Advocacy can be uncomfortable, but its necessary, Bleeding Disorders Awareness Month puts spotlight on education, Cheerful complaining helps me manage chronic illness flare-ups, Efanesoctocog alfa, now Altuviiio, approved in US for hemophilia A, The season of Lent helps remind me of my strengths as a caregiver, The sacred art of listening is critical for caregivers, EU approves Hemgenix, one-time gene therapy for hemophilia B, What I love most about my partner, who has hemophilia, Switching to low-fat dairy products skimmed milk or low-fat cheeses are good sources of vitamins and minerals as well as calcium, without the unnecessary fats. It also helps prevent damage to muscles and joints. The effect of ABO blood group on the diagnosis of von Willebrand disease. Hematologic consultation can guide decisions related to vWF replacement, optimization of hematologic parameters for epidural anesthesia placement, and use of vWF or factor VIII if necessary for the control of bleeding. Von Willebrand disease is the most common bleeding disorder. There are three types of VWD, and it's important to know which subtype you have . Translate. Because recombinant factor is made without plasma, it can reduce the risk of a viral infection or allergic reaction. Find a doctor Find a doctor Close find a doctor menu Back Find a Doctor. This medication is available as an injection (DDAVP). Connect with others like you for support and answers to your questions in the Blood Cancers & Disorders support group on Mayo Clinic Connect, a patient community. Accessed Aug. 26, 2021. A simple screening tool, which consists of a set of eight questions that focus on bleeding history, is equally sensitive to the pictorial bleeding assessment Box 2. Pregnancy can prove challenging for women with VWD because you run an increased risk of bleeding problems during . Von Willebrand disease (VWD) is an inherited bleeding disorder that prevents blood from clotting properly. This is measured my both amount (antigen level) of VWF as well as by function (activity level) of VWF. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 The link to von willebrand disease foods to avoid may be a bit more than just a nosebleed. Centers for Disease Control and Prevention. Bleeding events and other complications during pregnancy and childbirth in women with von Willebrand disease. This is the most common and mildest form of vWD. Von Willebrand disease is a type of clotting disorder - more common than the better known haemophilia. Foods to Avoid with Hemophilia. Von Willebrand disease affects 1% of the U.S. population and is the most common bleeding disorder in the United States. To understand von Willebrand disease, you first have to understand blood. Haemophilia 1999;5:3137. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement Learn more about how to . VWD is an inherited bleeding disorder where the body doesn't produce enough (or in some cases produces faulty) von Willebrand's factor, an essential blood protein for clotting. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. You still have small amounts of VWF in your body to help clot . Consider wearing a medical ID bracelet or necklace if you have a serious form of VWD (for example, type 3). Eating foods rich in calcium on a daily basis can help build strong bones that can withstand any future joint complications. 3/18/17, 5:10 AM by Hollie. If you dont drink milk, look for other, Having meat-free meals during the week incorporate dried beans, nuts and seeds into your menus. Physical activity helps keep muscles flexible. 9 Foods to Avoid with Diabetes Overview of bleeding disorders in adolescent females with menorrhagia. Von Willebrand disease is the most common inherited bleeding disorder among American women, with a prevalence of 0.61.3% 1. Patients with an underlying bleeding disorder are at a high risk of epidural or spinal hematoma 31. Have you ever felt a lump under the bruise? Recent guidelines on VWD have recommended taking a VWF level of 30 or 40 IU/dL as a cutoff for those diagnosed with the . Randomised comparative trial of the levonorgestrel intrauterine system and norethisterone for treatment of idiopathic menorrhagia. This content does not have an English version. Obstet Gynecol 2010;116:86575. Here's some information to help you get ready for your appointment. Phone: 1-800-936-1363. The first step in the evaluation of women with suspected bleeding disorders involves obtaining a detailed medical history and performing a physical examination 7 10. Careful screening is necessary to avoid delay in diagnosis. So, in the case of a nosebleed, a more definitive link would be a stroke. [, James AH, Manco-Johnson MJ, Yawn BP, Dietrich JE, Nichols WL. For Patients & Families . If you have von Willebrand disease, you might have: Excessive bleeding from an injury or after surgery or dental work. Connell NT, et al. . What will I need to do before having surgery or dental procedures? It can be inherited or, less commonly, develop later in life (this type of VWD is not heritable and is referred to as acquired von Willebrand syndrome [AVWS]). Drug Saf 2008;31:27582. American College of Obstetricians and Gynecologists. Have you had unexpected bruising? Von Willebrand disease is the most common type of bleeding disorder. American College of Obstetricians and Gynecologists. rarely, bleeding into joints or internal organs. The disease is usually an "autosomal dominant inherited" disorder, which means you need a mutated gene from only one parent to get the disease. However, women who have VWD can have bleeding problems during delivery. If you need relief for aches and pains, try acetaminophen (Tylenol, others) instead. von Willebrand disease (VWD) is a bleeding disorder. Desmopressin acetate is a synthetic derivative of the antidiuretic hormone vasopressin and works by stimulating the release of vWF from endothelial cells 7. Specific topics addressed in the report include initial screening, diagnosis, and management for patients with the disorder; along with directions for future research and recommendations for training for health professionals. Von Willebrand disease is the most common bleeding disorder, and affects males and females equally. 460. J Pediatr Adolesc Gynecol 2013;26:13841. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Keep your portions small avoid XL combos or meal packages that lead to being overweight, Avoid fried side dishes or order small sizes baked snacks like pretzels are low in fat, Try to eat slowly and if you can, bring half the food home to be eaten later, Beware of healthy smoothies as they pack lots of sugar. Bleeding disorders (including hemophilia) are rare. It is responsible for transporting blood clotting factor VII and this is why its deficiency results in an abnormal union of blood platelets. From the National Heart Lung and Blood Institute, National Institutes of Health. However, vWF and factor VIII levels are important to assess during pregnancy, including in the third trimester to facilitate planning for delivery and in the event of postpartum hemorrhage 12 15. Blood Advances. See if there is a diet that can improve the quality of life of people with Von Willebrand Disease, recommended and to avoid food when having Von Willebrand Disease Previous 1 answer Von Willebrand factor helps blood cells stick together (clot) when you bleed. Br J Haematol 2009;145:21220. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). National Organization for Rare Disorders. The most severe form of the condition is "autosomal recessive," which means both of your parents have to pass a mutated gene to you. Iron-rich foods include liver, lean red meat, poultry, leafy green vegetables, broccoli, dried beans, grains, and raisins. The study found that people who suffered from volebrand disease were more likely to have a stroke at any given time. Advertising revenue supports our not-for-profit mission. Its natural to eat a piece of cake at a party, but remember to compensate with fresh vegetables at your next meal. Although recent studies have suggested that interrupting combined hormonal contraceptive therapy for von Willebrand testing may be unnecessary 37, further research in this area is needed. Obstet Gynecol 2013;121:8916. In von Willebrand disease, there is not . Available at: Kingman CE, Kadir RA, Lee CA, Economides DL. There are three main types of von Willebrand disease. [, Dilley A, Drews C, Miller C, Lally C, Austin H, Ramaswamy D, et al. Type 1 VWD is most common. This means it takes longer for their blood to clot and for bleeding to stop. Obstet Gynecol 2001;97:6306. Save my name, email, and website in this browser for the next time I comment. People with the disease have low levels of von Willebrand factor, a protein that helps blood clot, or the protein doesn't perform as it should. Von Willebrand disease is a bleeding disorder. The pictorial bleeding assessment is a tool to specifically record the number of pads or tampons used during the menstrual period, how many times there was passage of clots, and the number of flooding accidents. The link to von willebrand disease foods to avoid is more than just a nosebleed, though. Have you had a nosebleed that lasted more than 10 minutes or needed medical attention? You might need to follow dietary restrictions or fast for 8-10 hours if blood tests are scheduled. This, along with the fact that it can cause bleeding in the nose and gums and sometimes even in the eyes, makes von willebrand disease foods to avoid one of those health scare foods we always have to have on hand. Data from Philipp CS, Faiz A, Dowling NF, Beckman M, Owens S, Ayers C, et al. But with treatment and self-care, most people with this disease can lead active lives. Who is at Risk for Antiphospholipid Antibody Syndrome? If you have von Willebrand disease, your doctor might suggest that family members undergo tests to determine if this condition runs in your family. Notably, a large epidemiologic study reported that the risk of postpartum hemorrhage for women with von Willebrand disease was 50% higher than for women without a bleeding disorder 32. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. All rights reserved.ISSN 1074-861XVon Willebrand disease in women. There are also subtypes of type 1 and type 2. A specific protein is missing from the blood so that injured blood vessels cannot heal in the usual way. It can sometimes be difficult to stick to your plans when you are eating eat out, but there are ways to avoid overeating orchoosing a meal that might not be good for you. Another replacement therapy approved by the Food and Drug Administration for treating adults 18 and older is a genetically engineered (recombinant) von Willebrand factor product. Development of a screening tool for identifying women with menorrhagia for hemostatic evaluation. Another replacement therapy approved by the Food and Drug Administration for treating adults 18 and . In children with Type II vWD, the von Willebrand factor itself has an abnormality. [, Chi C, Pollard D, Tuddenham EG, Kadir RA. Blood contains many proteins that help the blood clot when needed. The nutritional value of a salad is lost if you use too much high-calorie dressing, Choose lean meats, skip the cheese, or chose a low-fat cheese if its available. Von Willebrand disease (VWD) is a blood disorder in which the blood does not clot properly. [, James AH, Jamison MG. What Is Von Willebrand Disease? Collaboration with a hematologist is recommended to aid in the planning for gynecologic surgery and obstetric management (see Ref later in this document). Your treatment depends on: Your doctor might suggest one or more of the following treatments to increase your von Willebrand factor, strengthen blood clots or control heavy menstrual bleeding: Desmopressin. Fertil Steril 2005;84:13529. These cookies may also be used for advertising purposes by these third parties. A protein called von Willebrand factor helps blood clot. Talk with them about your diagnosis and suggest that they get tested too. People with VWD have a low level of a substance called von Willebrand factor in their blood, or it does not work very well. Von Willebrand Disease (vWD) is an inherited bleeding disorder that makes it difficult for blood to clot. [, Foster PA. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, DVT (deep vein thrombosis) prevention and treatment. Von Willebrand disease: Treatment of major bleeding and major surgery . In this case, Von willebrand disease is pretty rare, but its not a small risk. Antifibrinolytic agents, such as tranexamic acid and e-aminocaproic acid, can be effective nonhormonal treatment options for adolescents; however, their use in individuals younger than 18 years is considered off-label. As with the adult patient, a multidisciplinary approach to management, which involves both obstetriciangynecologists and hematologists, results in optimal treatment outcomes. In adolescents, fertility preservation is paramount; therefore, medical options should be used rather than surgical procedures. Talk with your health care team before starting any dietary supplement. [, Management of abnormal uterine bleeding associated with ovulatory dysfunction. It is caused by a lack of a specific protein that aids platelets (blood cells used in clotting) stick together and form clots to seal broken blood vessels. Von Willebrand disease is a blood clotting disorder that usually develops from an inherited genetic condition but can in rare cases develop alongside an autoimmune disease or . Have you had blood in your stool that wasn't explained by a known medical problem, such as a stomach ulcer or colon polyp?
Top 10 Largest College Marching Bands,
Prca Cowboy Bios,
Dead Air Wolfman 308,
Village Pointe Apartments Hawthorne,
Articles V