Von Willebrand factor in aortic or mitral valve stenosis and bleeding after heart valve surgery. Issue 198 (February 2021)

• Record Type: Journal Article
• Authors: Mazur, Piotr; Natorska, Joanna; Ząbczyk, Michał; Krzych, Łukasz; Litwinowicz, Radosław; Kędziora, Anna; Kapelak, Bogusław; Undas, Anetta
• Is Part Of: Thrombosis research. Issue 198(2021)
• Page Start: 190
• Page End: 195
• Publication Date: 2021-02
• Subjects: ADAMTS13 a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 -- AF atrial fibrillation -- APTT activated partial thromboplastin -- AS aortic stenosis -- AVR aortic valve replacement -- BMI body mass index -- CPB cardio-pulmonary bypass -- HMWM high-molecular-weight VWF multimers -- INR international normalized ratio -- MS mitral stenosis -- PAI-1 plasminogen activator inhibitor-1 -- TAFI thrombin activatable fibrinolysis inhibitor -- TAVI transcatheter aortic valve implantation -- UDPB universal definition of perioperative bleeding in cardiac surgery -- VARC-2 Valve Academic Research Consortium-2 -- VWF von Willebrand factor; von Willebrand factor -- VWF -- Aortic stenosis -- Mitral stenosis -- Cardiac surgery -- Bleeding; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2020.12.005
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Objectives: Low von Willebrand factor (VWF) increases the risk of bleeding. The objective was to assess the influence of VWF on bleeding after valvular surgery. Methods: We studied 82 consecutive patients in median age of 65.5 years with severe isolated aortic stenosis (AS, n = 62) or mitral stenosis (MS, n = 20), undergoing heart valve surgery in extracorporeal circulation. Preoperatively, we assessed VWF antigen (VWF:Ag) and activity (VWF:RCo), a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13), and fibrinolysis inhibitors. Results: Compared with AS, MS patients were more frequently female (80 vs. 55%, p = 0.045) with atrial fibrillation (AF) (80 vs. 8%, p < 0.0001), with no difference in age or comorbidities. Median postoperative drainage was 420 ml for AS, and 425 ml for MS ( p = 0.37). Patients with AS had lower VWF:RCo (125.8 [88.5–160.8] vs. 188.0 [140.3–207.3] IU/dl, p = 0.003) and VWF:Ag (135.8 [112.0–171.2] vs. 191.7 [147.3–236.4] IU/dl, p = 0.01) than MS patients. Mean VWF:RCo/Ag ratio was 0.88 ± 0.17, with no intergroup differences. ADAMTS13 levels and activity were similar in both groups. In AS, both VWF:RCo and VWF:Ag correlated inversely with maximal ( r = −0.39, p = 0.0003 and r = −0.39, p = 0.0004, respectively) and mean ( r = −0.40, p = 0.0004 and r = −0.39, p = 0.0006, respectively) transvalvular pressure gradients. There was no difference in perioperative bleeding between patients following mitral and aortic valve surgery, and bleeding was not associated with VWF:Ag or VWF:RCo. Conclusions: In severe AS, VWF levels and activity correlate inversely with transvalvular pressure gradients, and are lower than in severe degenerative MS, but do not affect blood loss after valvular surgery in extracorporeal circulation. Highlights: von Willebrand factor (VWF) may be involved in bleeding pathogenesis. VWF levels are higher in severe mitral stenosis than in aortic stenosis (AS). In AS VWF levels/activity correlate inversely with pressure gradients. Perioperative bleeding after aortic or mitral valve surgery has similar incidence. VWF does not affect bleeding after heart valve surgery for degenerative stenosis.