Systemic bevacizumab as salvage therapy for persistent severe bleeding and anemia in heyde syndrome following aortic valve replacement.
Zain M VirkAndrew B SongYousef R BadranDavid J KuterPublished in: Journal of thrombosis and thrombolysis (2022)
Heyde syndrome is characterized by the co-occurrence of aortic stenosis and bleeding gastrointestinal angiodysplasias, often with acquired von Willebrand syndrome. Current management for bleeding includes hematologic support with red cell transfusion and intravenous iron and correction of aortic stenosis with valve replacement. However, persistent Heyde syndrome after valve replacement occurs in a significant minority of cases, and there is no accepted therapy for these patients. Given that the pathophysiology of angiodysplasia formation in Heyde syndrome involves dysregulated angiogenesis, targeting angiogenesis may be an effective therapeutic option. We describe two cases of persistent Heyde syndrome with severe bleeding and anemia in patients following aortic valve replacement who were treated with systemic bevacizumab, a monoclonal antibody directed against vascular endothelial growth factor. In both cases, treatment was successful, with resolution of bleeding, liberation from hematologic support, and normalization of hemoglobin. In addition to responding to therapy, neither patient had treatment-related adverse events (and both had recurrent anemia upon treatment discontinuation, further evidence of the therapeutic impact of bevacizumab). Additional investigation into the use of systemic antiangiogenic therapy for treatment of Heyde syndrome is warranted.
Keyphrases
- aortic stenosis
- aortic valve replacement
- ejection fraction
- aortic valve
- transcatheter aortic valve implantation
- transcatheter aortic valve replacement
- case report
- vascular endothelial growth factor
- atrial fibrillation
- newly diagnosed
- endothelial cells
- coronary artery disease
- heart failure
- prognostic factors
- mitral valve
- combination therapy
- monoclonal antibody
- early onset
- stem cells
- high dose
- mesenchymal stem cells
- iron deficiency
- cell therapy
- acute kidney injury
- bone marrow
- red blood cell