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Effects of transcutaneous aortic valve implantation on aortic valve disease-related hemostatic disorders involving von Willebrand factor.
Can J Cardiol 2015; 31(6):738-43CJ

Abstract

BACKGROUND

Aortic valve stenosis (AVS) can be complicated by bleeding associated with acquired type 2A von Willebrand syndrome. The association of AVS and gastrointestinal bleeding from angiodysplasia is defined as Heyde syndrome. We sought to evaluate the effect of transcutaneous aortic valve implantation (TAVI) on hemostasis disorders and to assess its effectiveness to treat Heyde syndrome.

METHODS

We prospectively enrolled 49 consecutive patients with severe AVS addressed for TAVI at our institution. Biological hemostasis parameters involving von Willebrand factor (vWF) were assessed at baseline and 1 week after the procedure.

RESULTS

At baseline, a significant link between vWF abnormalities and the severity of AVS was evidenced: mean aortic transvalvular gradient was negatively correlated with the levels of vWF antigen (vWF:Ag) (r = -0.29; P < 0.05), vWF ristocetin cofactor activity (r = -0.402; P = 0.006), and vWF collagen-binding activity (vWF:CB; r = -0.441; P = 0.005). One week after the procedure, a significant increase of vWF:Ag, vWF ristocetin cofactor activity, and vWF:CB was evidenced in the whole cohort (respectively, 3.32 vs. 2.29 IU/mL, P < 0.001; 2.98 vs. 1.86 IU/mL, P < 0.001; and 3.16 vs. 2.16 IU/mL, P < 0.001). Patients with pre-TAVI vWF abnormalities consistent with a type 2A vWF syndrome (ratio vWF:CB/vWF:Ag < 0.7) preferentially improved their vWF function with respect to patients with a normal ratio (relative increase of vWF:CB of 63.8% vs. 3.5%).

CONCLUSIONS

Hemostasis parameters involving vWF are improved after TAVI, especially in patients with pre-existing abnormalities consistent with acquired type 2A von Willebrand syndrome.

Authors+Show Affiliations

Department of Cardiology, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France. Electronic address: thibault.caspar@chru-strasbourg.fr.Department of Cardiology, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.Laboratory of Hematology, Universty Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.Laboratory of Hematology, Universty Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.Department of Cardiology, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.Department of Cardiology, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.Department of Cardiology, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.Department of Cardiovascular Surgery, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.Department of Cardiology, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.Department of Cardiology, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25935884

Citation

Caspar, Thibault, et al. "Effects of Transcutaneous Aortic Valve Implantation On Aortic Valve Disease-related Hemostatic Disorders Involving Von Willebrand Factor." The Canadian Journal of Cardiology, vol. 31, no. 6, 2015, pp. 738-43.
Caspar T, Jesel L, Desprez D, et al. Effects of transcutaneous aortic valve implantation on aortic valve disease-related hemostatic disorders involving von Willebrand factor. Can J Cardiol. 2015;31(6):738-43.
Caspar, T., Jesel, L., Desprez, D., Grunebaum, L., Samet, H., Trinh, A., ... Morel, O. (2015). Effects of transcutaneous aortic valve implantation on aortic valve disease-related hemostatic disorders involving von Willebrand factor. The Canadian Journal of Cardiology, 31(6), pp. 738-43. doi:10.1016/j.cjca.2015.01.012.
Caspar T, et al. Effects of Transcutaneous Aortic Valve Implantation On Aortic Valve Disease-related Hemostatic Disorders Involving Von Willebrand Factor. Can J Cardiol. 2015;31(6):738-43. PubMed PMID: 25935884.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of transcutaneous aortic valve implantation on aortic valve disease-related hemostatic disorders involving von Willebrand factor. AU - Caspar,Thibault, AU - Jesel,Laurence, AU - Desprez,Dominique, AU - Grunebaum,Lélia, AU - Samet,Hafida, AU - Trinh,Annie, AU - Petit-Eisenmann,Hélène, AU - Kindo,Michel, AU - Ohlmann,Patrick, AU - Morel,Olivier, Y1 - 2015/01/24/ PY - 2014/12/10/received PY - 2015/01/21/revised PY - 2015/01/21/accepted PY - 2015/5/4/entrez PY - 2015/5/4/pubmed PY - 2015/8/8/medline SP - 738 EP - 43 JF - The Canadian journal of cardiology JO - Can J Cardiol VL - 31 IS - 6 N2 - BACKGROUND: Aortic valve stenosis (AVS) can be complicated by bleeding associated with acquired type 2A von Willebrand syndrome. The association of AVS and gastrointestinal bleeding from angiodysplasia is defined as Heyde syndrome. We sought to evaluate the effect of transcutaneous aortic valve implantation (TAVI) on hemostasis disorders and to assess its effectiveness to treat Heyde syndrome. METHODS: We prospectively enrolled 49 consecutive patients with severe AVS addressed for TAVI at our institution. Biological hemostasis parameters involving von Willebrand factor (vWF) were assessed at baseline and 1 week after the procedure. RESULTS: At baseline, a significant link between vWF abnormalities and the severity of AVS was evidenced: mean aortic transvalvular gradient was negatively correlated with the levels of vWF antigen (vWF:Ag) (r = -0.29; P < 0.05), vWF ristocetin cofactor activity (r = -0.402; P = 0.006), and vWF collagen-binding activity (vWF:CB; r = -0.441; P = 0.005). One week after the procedure, a significant increase of vWF:Ag, vWF ristocetin cofactor activity, and vWF:CB was evidenced in the whole cohort (respectively, 3.32 vs. 2.29 IU/mL, P < 0.001; 2.98 vs. 1.86 IU/mL, P < 0.001; and 3.16 vs. 2.16 IU/mL, P < 0.001). Patients with pre-TAVI vWF abnormalities consistent with a type 2A vWF syndrome (ratio vWF:CB/vWF:Ag < 0.7) preferentially improved their vWF function with respect to patients with a normal ratio (relative increase of vWF:CB of 63.8% vs. 3.5%). CONCLUSIONS: Hemostasis parameters involving vWF are improved after TAVI, especially in patients with pre-existing abnormalities consistent with acquired type 2A von Willebrand syndrome. SN - 1916-7075 UR - https://www.unboundmedicine.com/medline/citation/25935884/Effects_of_transcutaneous_aortic_valve_implantation_on_aortic_valve_disease_related_hemostatic_disorders_involving_von_Willebrand_factor_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0828-282X(15)00037-9 DB - PRIME DP - Unbound Medicine ER -