title: Von Willebrand factor, a versatile player in gastrointestinal bleeding in left ventricular assist device recipients?
abstract: BACKGROUND
  Bleeding originating in the gastrointestinal (GI) tract is one of the most common adverse events after left ventricular assist device (LVAD) implantation. In these patients, GI bleeding appears to be the consequence of altered hemostasis on the one hand and alterations of the GI microvasculature on the other.
  
  
  METHODS
  We report the case of a patient who suffered repeated, severe GI bleeding early after implantation of a HeartMate II continuous-flow LVAD.
  
  
  RESULTS
  After failure of conventional treatment strategies, GI bleeding was controlled using repeated transfusions of a purified von Willebrand factor (VWF) concentrate, almost devoid of Factor VIII (Wilfactin, LFB). No episodes of pump thrombosis were noted. Subsequent to VWF transfusions, we observed a progressive normalization of circulating vascular endothelial growth factor levels.
  
  
  CONCLUSIONS
  Our data raise the possibility that, in addition to its hemostatic properties, transfusions of VWF might have acted as an antiangiogenic factor.
authors: Department of Cardiology, AP-HP Bichat Hospital, Paris, France.
authors: Quentin
authors: Q
authors: Fischer
authors: Marie-Geneviève
authors: MG
authors: Huisse
authors: Guillaume
authors: G
authors: Voiriot
authors: Claudine
authors: C
authors: Caron
authors: Laurent
authors: L
authors: Lepage
authors: Marie-Pierre
authors: MP
authors: Dilly
authors: Patrick
authors: P
authors: Nataf
authors: Nadine
authors: N
authors: Ajzenberg
authors: Matthias
authors: M
authors: Kirsch
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D004621:Embolization, Therapeutic; D017707:Erythrocyte Transfusion; D005340:Fibrinogen / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006352:Heart Ventricles; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D018919:Neovascularization, Physiologic / Q000187:drug effects; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D012008:Recurrence; D014148:Tranexamic Acid / Q000627:therapeutic use; D014841:von Willebrand Factor / Q000502:physiology / Q000627:therapeutic use*
chemical_list: D006490:Hemostatics; D014841:von Willebrand Factor; D014148:Tranexamic Acid; D005340:Fibrinogen; D003894:Deamino Arginine Vasopressin