Alarming Increasing Trends in Hospitalizations and Mortality With Heyde's Syndrome: A Nationwide Inpatient Perspective (2007 to 2014)

Desai, Rupak; Parekh, Tarang; Singh, Sandeep; Patel, Upenkumar; Fong, Hee Kong; Zalavadia, Dipen; Savani, Sejal; Doshi, Rajkumar; Sachdeva, Rajesh; Kumar, Gautam

doi:10.1016/j.amjcard.2018.12.043

Cited by 22 publications

(21 citation statements)

References 25 publications

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“…More than 60 years ago, this association was first described by Edward Heyde. Twenty-eight years after his discovery, angiodysplasias were identified as the source of GI bleeding in the majority of these patients [8,9]. Later studies not only confirmed the acquired deficiency of vWF multimers in these patients, but also revealed improvement in bleeding with increased levels of vWF multimers after valve replacement procedure.…”

Section: Discussionmentioning

confidence: 95%

Heyde’s Syndrome Complicating Management in a Patient With High Bleeding and Thrombotic Risks

Ahmed

Haque

2020

Cureus

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The association of severe aortic stenosis and gastrointestinal (GI) bleeding is a well-known phenomenon. The pathogenesis involves an acquired deficiency of von Willebrand factor (vWF) due to shear stress resulting in alteration of vWF morphology. This results in inappropriate cleavage of vWF multimers into smaller dysfunctional fragments. Patients with atrial fibrillation and high thrombotic risk require anticoagulation for stroke prophylaxis. We describe a case of severe intermittent GI bleeding in a patient with atrial fibrillation while being on warfarin and other novel anticoagulants. This case highlights the role of severe aortic stenosis and resultant acquired vWF deficiency in complicating decision making in patients with a need for anticoagulation due to high thrombotic risk.

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Section: Discussionmentioning

confidence: 95%

Heyde’s Syndrome Complicating Management in a Patient With High Bleeding and Thrombotic Risks

Ahmed

Haque

2020

Cureus

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“…2 AS is common among the elderly, 1 and its prevalence increases with age, from 1% to 2% at age 75 years to 6% at age 85 years. 3 Heyde syndrome is reported in approximately 25% of patients with severe AS. 1 The association between AS and GI bleeding has been questioned, but evidence of GI bleeding resolution after surgical aortic valve replacement reinforced the association.…”

Section: Introductionmentioning

confidence: 99%

“…From 2007 to 2014, data acquired from the National Inpatient Sample showed that hospitalizations and all-cause inpatient mortality associated with Heyde syndrome increased 29.16% (from 48 to 62 per 100,000) and 22.70% (from 3.7 to 4.54 per 100,000), respectively. 3 A Dieulafoy lesion, a rare and specific type of angiodysplasia, is a large, tortuous, submucosal end artery that penetrates through the gastric mucosa over time. 4 The lesion can eventually perforate and cause severe GI bleeding.…”

Section: Introductionmentioning

confidence: 99%

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Heyde Syndrome Complicated by a Dieulafoy Lesion

Abdullah¹,

Abadco

2020

TOJ

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Background: Heyde syndrome, a triad of aortic stenosis, von Willebrand factor deficiency, and gastrointestinal (GI) bleeding from angiodysplasia, is a disease of the elderly. A Dieulafoy lesion, a specific type of angiodysplasia, is a large, tortuous, submucosal end artery that penetrates through the gastric mucosa and can cause life-threatening GI bleeding. We present a case of Heyde syndrome complicated by a Dieulafoy lesion. Case Report: A 72-year-old female presented with GI bleeding evidenced by black tarry stool for 7 days. Hemoglobin (Hgb) level was as low as 6.0 g/dL. Double-balloon enteroscopy (DBE) revealed 2 jejunal angiodysplasias that were treated with argon plasma coagulation. The patient continued to have dark stools after discharge. Repeat complete blood count showed Hgb of 6.2 g/dL, and repeat DBE showed a 1-mm focus of active bleeding in the proximal jejunum consistent with a Dieulafoy lesion. The lesion was successfully treated with argon plasma at 1 L/min and 25 watts. At follow-up 1 year later, the patient had had no GI bleeding symptoms since discharge. Conclusion: This case adds evidence that a Dieulafoy lesion is a potential complication of Heyde syndrome. Dieulafoy lesions can be life-threatening, so documenting occurrences that are complications of Heyde syndrome is important because of the potential for an increasing incidence of Heyde syndrome in the aging population.

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“…9,10,12 In addition, bleeds may be augmented by coexisting conditions, such as older age, frailty, fall risk, renal failure, liver disease, malignancy, anaemia and coagulation disorders, as well as by AF and antithrombotic therapy. [59][60][61][62][63][64] Finally, a periprocedural thrombo-inflammatory state and reduced platelet turnover in the older patient may act synergistically, resulting in transient thrombocytopenia in 69-87% of TAVI patients, signalling severe impairment of general homeostasis. [65][66][67] Gastrointestinal bleeding associated with aortic stenosis is due to the shear stress and flow turbulence across the stenotic aortic valve, which may cause the cleavage of high-molecular-weight multimers of von Willebrand factor, a coagulation protein responsible for haemostasis.…”

Section: Bleeding Eventsmentioning

confidence: 99%

Anticoagulation after Transcatheter Aortic Valve Implantation: Current Status

Greco

Capodanno

2020

Interv Cardiol

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Transcatheter aortic valve implantation (TAVI) is the standard of care for symptomatic severe aortic stenosis. Antithrombotic therapy is required after TAVI to prevent thrombotic complications but it increases the risk of bleeding events. Current clinical guidelines are mostly driven by expert opinion and therefore yield low-grade recommendations. The optimal antithrombotic regimen following TAVI has yet to be determined and several randomised controlled trials assessing this issue are ongoing. The purpose of this article is to critically explore the impact of antithrombotic drugs, especially anticoagulants, on long-term clinical outcomes following successful TAVI.

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Alarming Increasing Trends in Hospitalizations and Mortality With Heyde's Syndrome: A Nationwide Inpatient Perspective (2007 to 2014)

Cited by 22 publications

References 25 publications

Heyde’s Syndrome Complicating Management in a Patient With High Bleeding and Thrombotic Risks

Heyde’s Syndrome Complicating Management in a Patient With High Bleeding and Thrombotic Risks

Heyde Syndrome Complicated by a Dieulafoy Lesion

Anticoagulation after Transcatheter Aortic Valve Implantation: Current Status

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