title: Increased bleeding risk in patients with aortic valvular stenosis: From new mechanisms to new therapies.
abstract: Aortic stenosis (AS), the most prevalent acquired valvular disease in the adults that requires invasive treatment, coexists with coagulopathy, resulting in bleeding in approximately 20% of patients. In the current review, we summarize the available knowledge on the mechanisms underlying the bleeding tendency observed in AS, and discuss potential compensatory mechanisms preventing most patients with severe AS from experiencing bleeding. We offer an update on Heyde's syndrome and other types of bleeding, and study extensively their pathobiology, providing insights into the new emerging concepts on coagulation regulation in AS. The focus is given to the impact of valvular interventions on coagulation abnormalities in AS. Both surgical valve replacement and transcatheter aortic valve implantation are discussed. Finally, we discuss current treatment recommendations in AS related bleeding.
authors.affiliation: Institute of Cardiology, Jagiellonian University School of Medicine, Krakow, Poland; John Paul II Hospital, Krakow, Poland. Electronic address: j.natorska@szpitaljp2.krakow.pl.
authors.forename: Joanna
authors.initials: J
authors.lastname: Natorska
authors.affiliation: Institute of Cardiology, Jagiellonian University School of Medicine, Krakow, Poland; John Paul II Hospital, Krakow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Mazur
authors.affiliation: Institute of Cardiology, Jagiellonian University School of Medicine, Krakow, Poland; John Paul II Hospital, Krakow, Poland.
authors.forename: Anetta
authors.initials: A
authors.lastname: Undas
mesh_terms: D000818:Animals; D001024:Aortic Valve Stenosis / Q000097:blood / Q000150:complications*; D001777:Blood Coagulation; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006470:Hemorrhage / Q000097:blood / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015539:Platelet Activation; D012306:Risk; D013917:Thrombin / Q000032:analysis / Q000378:metabolism; D014842:von Willebrand Diseases / Q000097:blood / Q000209:etiology / Q000628:therapy
chemical_list: D013917:Thrombin
keywords: Aortic stenosis; Bleeding; Coagulation; Heyde syndrome; Valve replacement; von Willebrand factor