In plasma, proteolysis may occur while VWF is being exposed to elongational flows and/or increased laminar shear rates21, 31 and the importance of this pathway is illustrated by the rapid appearance (within 15 min) of VWF degradation products following the infusion of recombinant non-proteolyzed VWF in VWD-type 3 patients32. Here, VWF is linked to von Willebrand disease 3.