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Gastrointestinal bleeding, angiodysplasia, cardiovascular disease, and acquired von Willebrand syndrome.
Transfus Med Rev 2003; 17(4):272-86TM

Abstract

Recent evidence points to isolated deficiency of the largest multimers of von Willebrand factor (VWF)-known as von Willebrand syndrome type 2A (VWS-2A)-as a risk factor for bleeding from gastrointestinal (GI) angiodysplasia. This disorder is not widely recognized, perhaps because most patients do not exhibit generalized hemostatic impairment (bleeding is generally restricted to GI angiodysplasia) and because all but the largest multimers of VWF remain detectable in the plasma (thus, routine screening tests for VWS-2A are usually normal). The "Rosetta stone" for elucidating this syndrome was the enigma of Heyde's syndrome (aortic stenosis plus bleeding GI angiodysplasia), particularly the striking observation that aortic valve replacement generally cures GI bleeding and that preoperative deficiency of the largest VWF multimers undergoes long-term normalization after valve replacement. We critically review the evidence implicating VWS-2A as a risk factor for bleeding GI angiodysplasia. We hypothesize that VWS-2A secondary to cardiovascular disease other than severe aortic stenosis, such as peripheral arterial occlusive disease, could explain why elderly patients often develop recurrent GI bleeding or iron deficiency anemia from GI angiodysplasia.

Authors+Show Affiliations

Department of Pathology, McMaster University, Hamilton, Ontario, Canada. twarken@mcmaster.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

14571395

Citation

Warkentin, Theodore E., et al. "Gastrointestinal Bleeding, Angiodysplasia, Cardiovascular Disease, and Acquired Von Willebrand Syndrome." Transfusion Medicine Reviews, vol. 17, no. 4, 2003, pp. 272-86.
Warkentin TE, Moore JC, Anand SS, et al. Gastrointestinal bleeding, angiodysplasia, cardiovascular disease, and acquired von Willebrand syndrome. Transfus Med Rev. 2003;17(4):272-86.
Warkentin, T. E., Moore, J. C., Anand, S. S., Lonn, E. M., & Morgan, D. G. (2003). Gastrointestinal bleeding, angiodysplasia, cardiovascular disease, and acquired von Willebrand syndrome. Transfusion Medicine Reviews, 17(4), pp. 272-86.
Warkentin TE, et al. Gastrointestinal Bleeding, Angiodysplasia, Cardiovascular Disease, and Acquired Von Willebrand Syndrome. Transfus Med Rev. 2003;17(4):272-86. PubMed PMID: 14571395.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gastrointestinal bleeding, angiodysplasia, cardiovascular disease, and acquired von Willebrand syndrome. AU - Warkentin,Theodore E, AU - Moore,Jane C, AU - Anand,Sonia S, AU - Lonn,Eva M, AU - Morgan,David G, PY - 2003/10/23/pubmed PY - 2004/7/9/medline PY - 2003/10/23/entrez SP - 272 EP - 86 JF - Transfusion medicine reviews JO - Transfus Med Rev VL - 17 IS - 4 N2 - Recent evidence points to isolated deficiency of the largest multimers of von Willebrand factor (VWF)-known as von Willebrand syndrome type 2A (VWS-2A)-as a risk factor for bleeding from gastrointestinal (GI) angiodysplasia. This disorder is not widely recognized, perhaps because most patients do not exhibit generalized hemostatic impairment (bleeding is generally restricted to GI angiodysplasia) and because all but the largest multimers of VWF remain detectable in the plasma (thus, routine screening tests for VWS-2A are usually normal). The "Rosetta stone" for elucidating this syndrome was the enigma of Heyde's syndrome (aortic stenosis plus bleeding GI angiodysplasia), particularly the striking observation that aortic valve replacement generally cures GI bleeding and that preoperative deficiency of the largest VWF multimers undergoes long-term normalization after valve replacement. We critically review the evidence implicating VWS-2A as a risk factor for bleeding GI angiodysplasia. We hypothesize that VWS-2A secondary to cardiovascular disease other than severe aortic stenosis, such as peripheral arterial occlusive disease, could explain why elderly patients often develop recurrent GI bleeding or iron deficiency anemia from GI angiodysplasia. SN - 0887-7963 UR - https://www.unboundmedicine.com/medline/citation/14571395/Gastrointestinal_bleeding_angiodysplasia_cardiovascular_disease_and_acquired_von_Willebrand_syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0887796303000373 DB - PRIME DP - Unbound Medicine ER -