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Aortic stenosis and the haemostatic system
Antonin Trimaille1,2, Sandy Hmadeh2, Kensuke Matsushita1,2
1Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l'hôpital 67000 Strasbourg, France.
Insights
Aortic stenosis (AS) involves the hemostatic system, increasing risks like heart failure and stroke. Understanding this link is key for new treatments and managing outcomes after valve replacement.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Pathophysiology
Background:
- Aortic stenosis (AS) affects over 10% of individuals older than 80, posing significant risks for heart failure, stroke, and mortality.
- AS pathogenesis is complex, involving endothelial dysfunction, inflammation, fibrosis, and calcification, with a critical interplay with the hemostatic system.
Approach:
- This review synthesizes current evidence on the relationship between aortic stenosis and prothrombotic activity.
- It examines the role of platelets, coagulation factors, von Willebrand factor, and micro-particles in AS progression.
Key Points:
- The hemostatic system is intricately involved in all stages of aortic stenosis pathogenesis.
- Persistent biological activity of native valves post-transcatheter aortic valve replacement can lead to microthrombosis, potentially affecting new valve function.
Conclusions:
- A comprehensive understanding of the AS-hemostasis interaction is essential for developing effective prophylactic treatments.
- Clinical consequences of these interactions, particularly after aortic valve replacement, warrant further emphasis and investigation.
Abstract:
Aortic stenosis (AS) affects more than 10% of the population over 80 years of age and constitutes a major risk factor for heart failure, thromboembolic stroke, and death. A better understanding of the disease, including its interaction with the haemostatic system, is a prerequisite to develop prophylactic treatments. AS pathogenesis is a dynamic process involving endothelial dysfunction, inflammation, fibrosis, and calcification. Several studies support the interplay between the components of the haemostatic system such as platelets, the coagulation system, von Willebrand factor, and extracellular micro-particles at each pathophysiological stage of AS. Previous reports have evidenced persistent biological activity of the native valve after transcatheter aortic valve replacement and the subsequent development of microthrombosis that may impact the function of the newly implanted valve. Here, we review the current evidence on the interplay between AS and prothrombotic activity, and we emphasize the clinical consequences of these interactions after aortic valve replacement.
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