{"id":5767,"date":"2026-10-19T09:51:41","date_gmt":"2026-10-19T07:51:41","guid":{"rendered":"https:\/\/cvja.co.za\/journal\/?p=5767"},"modified":"2026-10-19T09:51:41","modified_gmt":"2026-10-19T07:51:41","slug":"cvja-2026-050","status":"publish","type":"post","link":"https:\/\/cvja.co.za\/journal\/cvja-2026-050\/","title":{"rendered":"Examination of acquired coagulopathy in patients with aortic stenosis"},"content":{"rendered":"    <div id=\"article\">                                                                                                                        \r\n        <div id=\"title-container\">                                                                                                    \r\n        <div id=\"authors-title\">                                                                                                            \r\n        <!--Aurthors under Title-->                                                                                                            \r\n            \r\nMirac Tonyal\u0131, Derya Bayk\u0131z, Elif A. Govdeli, Abdurrahman F. Aydin, Aytac Oncul\r\n<\/div>        \r\n<\/div>                                                                                                                            \r\n            <div id=\"copyright\">\r\n        <strong>Copyright:<\/strong> Clinics Cardive Publishing (Pty) Ltd. publisher\r\n        of Cardiovascular Journal of Africa.<\/div>\r\n    <div style=\"clear: both;\"><\/div>                                                                                                                                \r\n        <div id=\"article-abstract\">                                                                                                            \r\n            <div id=\"abstract-title\">                                                                                                        \r\n                    Abstract                                                                                                                \r\n                <\/div>                                                                                                                        \r\n                                                                                                                                \r\n            <div id=\"abstract-content\">                                                                                                        \r\n            <!--Content of Abstract Article-->                                                                                                \r\n            <!--<strong>\"Abstract titles\":<\/strong>-->                                                                                        \r\n            <!--<br\/> at the end of each section!!-->                                                                                        \r\n                                                                                                                                                    \r\n        <strong>Background:<\/strong>                                                                                                    \r\n                                                                                                                                                    \r\nAortic stenosis (AS) is one of the cardiovascular diseases with an increasing prevalence and is associated with high morbidity. In this patient population, bleeding diathesis represents a significant challenge in clinical management. Although the acquired coagulopathy detected in patients with AS has yielded heterogeneous results in the literature, it has been associated with alterations in von Willebrand factor (vWF) levels and activity and is commonly defined as acquired type 2A von Willebrand disease. The aim of this study was to investigate the relationship between von Willebrand factor antigen (vWF:Ag), von Willebrand factor activity (vWF:Ac), Factor VIII (FVIII) activity, and the vWF:Ac\/vWF:Ag ratio with the severity and aetiology of AS and bleeding diathesis.\r\n<br \/>           \r\n\r\n        <strong>Methods:<\/strong>                                                                                                    \r\n                                                                                                                                                    \r\nThe study was conducted using a prospective observational design. A total of 78 individuals were included in the study, comprising 48 patients diagnosed with AS and 30 control group participants. The demographic data, echocardiography findings, vWF:Ag, vWF:Ac, FVIII activity, and the vWF:Ac\/vWF:Ag and FVIII\/vWF:Ag ratios of all participants were evaluated. Patients were divided into subgroups based on the severity of AS, its aetiology, and the presence of a bleeding history, and subgroup analyses were performed.\r\n<br \/>            \r\n                                                                                                                                                                                                                                                                        \r\n                                                                                                                                                \r\n        <strong>Results:<\/strong>                                                                                                    \r\n                                                                                                                                                    \r\nCompared with controls, patients with AS had significantly higher vWF:Ag (p = 0.031) and a lower vWF:Ac\/vWF:Ag ratio (p < 0.001), whereas vWF:Ac and FVIII activity were comparable between the groups. The vWF:Ac\/vWF:Ag ratio remained significantly lower in both mild and severe AS and across different aetiologies compared with controls. Among patients without bleeding, vWF:Ac and the vWF:Ac\/vWF:Ag ratio were significantly lower than that in both patients with bleeding and controls. ROC analysis identified vWF:Ag > 121.7% and FVIII > 136.7% as markers associated with the primary composite endpoint, with 73.3% sensitivity and 60.3% specificity. However, in multivariable Cox regression analysis, only diabetes mellitus, higher FVIII activity, and lower haemoglobin levels remained independent predictors of the primary composite endpoint.\r\n<br \/>    \r\n\r\n        <strong>Conclusion:<\/strong>                                                                                                    \r\n                                                                                                                                                    \r\nAlterations in coagulation parameters in patients with AS do not fully correspond to acquired type 2A von Willebrand disease, suggesting that bleeding diathesis is likely a multifactorial process rather than the consequence of a single mechanism. In addition, the association of vWF:Ag and FVIII activity with the primary composite endpoint suggests potential prognostic value beyond bleeding risk. However, these findings should be interpreted with caution and require confirmation in larger prospective studies before routine clinical application.\r\n<br \/>    \r\n                                                                                                                                         \r\n            <\/div>                                                                                                                            \r\n        <\/div>                                                                                                                                    \r\n                                                                                                                                        \r\n                                                                                                                                                \r\n        <div id=\"keywords\">                                                                                                                    \r\n                                                                                                                                            \r\n            <strong>Keywords:<\/strong>                                                                                                        \r\n                                                                                                                                            \r\n            <strong>heart valve disease, aortic stenosis, acquired coagulopathy, von Willebrand factor, Heyde syndrome<\/strong>                                                                                                                                                                                                                    \r\n                                                                                                                                                \r\n        <\/div>                                                                                                                                    \r\n                                                                                                                                                \r\n    <div id=\"publish-info\">                                                                                                                    \r\n                                                                                                                                \r\n    <strong>Submitted:<\/strong> March 10, 2026; <!--Month day, year; -->    \r\n    <strong>Accepted:<\/strong> July 20, 2026; <!--Month day, year; -->                                                                            \r\n    <strong>Published:<\/strong> October 16, 2026<!--Month day, year; -->                                                                                                                            <br \/>                                                            \r\n        <em>Cardiovasc J Afr 2025; <b>37<\/b>: 468-477<!--pg no. till pg no. \"eg. 4-7\"--><\/em>\r\n        <br \/><strong>Volume 37, Issue 4<\/strong> <br \/>                                                                            \r\n        <\/div>                                                                                                                            \r\n                                                                                                                                        \r\n    <div id=\"DOI\">                                                                                                                    \r\n            DOI Citation Reference: dx.doi.org\/10.5830\/CVJA-2026-050<!--DOI number-->                                                                \r\n        <\/div>                                                                                                                            \r\n                \r\n                <div id=\"author-affiliation\">                                                                                                \r\n \r\n<strong>Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, T\u00fcrkiye\r\n<\/strong>    <br \/>                                                                            \r\nMirac Tonyal\u0131<br \/>\r\nDerya Bayk\u0131z<br \/>\r\nAytac Oncul\r\n<br \/><br \/>     \r\n\r\n<strong>Royal Brompton Hospital, London, United Kingdom\r\n<\/strong>    <br \/>                                                                            \r\nElif A. Govdeli\r\n<br \/><br \/>  \r\n\r\n<strong>Department of Medical Biochemistry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, T\u00fcrkiye\r\n<\/strong>    <br \/>                                                                            \r\nAbdurrahman F. Aydin\r\n<br \/><br \/>  \r\n\r\n\r\n                [soshsc hide=\"logged\"]\r\n                \r\n                <strong>You need to be <a style=\"color: #c80c44;\" href=\"https:\/\/cvja.co.za\/journal\/member-login\/\" target=\"_blank\" rel=\"noopener\">logged in to view and download<\/a> the full text PDF version. <a style=\"color: #c80c44;\" href=\"https:\/\/cvja.co.za\/journal\/register\/\" target=\"_blank\" rel=\"noopener\">Register for a free account?<\/a><\/strong> <br \/><br \/>[\/soshsc]\r\n                \r\n                \r\n                \r\n                <\/div>\r\n    \r\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Aortic stenosis (AS) is one of the cardiovascular diseases with an increasing prevalence and is associated with high morbidity. In this patient population, bleeding diathesis represents a significant challenge in clinical management. <\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[44,112],"tags":[],"class_list":["post-5767","post","type-post","status-publish","format-standard","hentry","category-cardiovascular-topics","category-volume-37-issue-4"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Examination of acquired coagulopathy in patients with aortic stenosis - Cardiovascular Journal of Africa<\/title>\n<meta name=\"description\" content=\"Aortic stenosis (AS) is one of the cardiovascular diseases with an increasing prevalence and is associated with high morbidity. In this patient population, bleeding diathesis represents a significant challenge in clinical management.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cvja.co.za\/journal\/cvja-2026-050\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Examination of acquired coagulopathy in patients with aortic stenosis - Cardiovascular Journal of Africa\" \/>\n<meta property=\"og:description\" content=\"Aortic stenosis (AS) is one of the cardiovascular diseases with an increasing prevalence and is associated with high morbidity. In this patient population, bleeding diathesis represents a significant challenge in clinical management.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cvja.co.za\/journal\/cvja-2026-050\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiovascular Journal of Africa\" \/>\n<meta property=\"article:published_time\" content=\"2026-10-19T07:51:41+00:00\" \/>\n<meta name=\"author\" content=\"Jaco Moolman\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Jaco Moolman\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/cvja.co.za\/journal\/cvja-2026-050\/\",\"url\":\"https:\/\/cvja.co.za\/journal\/cvja-2026-050\/\",\"name\":\"Examination of acquired coagulopathy in patients with aortic stenosis - Cardiovascular Journal of Africa\",\"isPartOf\":{\"@id\":\"https:\/\/cvja.co.za\/journal\/#website\"},\"datePublished\":\"2026-10-19T07:51:41+00:00\",\"author\":{\"@id\":\"https:\/\/cvja.co.za\/journal\/#\/schema\/person\/6bf8a30a039e93fd8112db707affb920\"},\"description\":\"Aortic stenosis (AS) is one of the cardiovascular diseases with an increasing prevalence and is associated with high morbidity. In this patient population, bleeding diathesis represents a significant challenge in clinical management.\",\"breadcrumb\":{\"@id\":\"https:\/\/cvja.co.za\/journal\/cvja-2026-050\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cvja.co.za\/journal\/cvja-2026-050\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cvja.co.za\/journal\/cvja-2026-050\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cvja.co.za\/journal\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Examination of acquired coagulopathy in patients with aortic stenosis\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cvja.co.za\/journal\/#website\",\"url\":\"https:\/\/cvja.co.za\/journal\/\",\"name\":\"Cardiovascular Journal of Africa\",\"description\":\"The Cardiovascular Journal of Africa is a peer-reviewed medical journal publishing leading research in cardiovascular health across Africa since 1990\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/cvja.co.za\/journal\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/cvja.co.za\/journal\/#\/schema\/person\/6bf8a30a039e93fd8112db707affb920\",\"name\":\"Jaco Moolman\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/cvja.co.za\/journal\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/454c6719ed785bfd40e036ca3c3ac3347c56b4a99902df8beb62d882b1e6967f?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/454c6719ed785bfd40e036ca3c3ac3347c56b4a99902df8beb62d882b1e6967f?s=96&d=mm&r=g\",\"caption\":\"Jaco Moolman\"},\"url\":\"https:\/\/cvja.co.za\/journal\/author\/jacodesignconnection-co-za\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Examination of acquired coagulopathy in patients with aortic stenosis - Cardiovascular Journal of Africa","description":"Aortic stenosis (AS) is one of the cardiovascular diseases with an increasing prevalence and is associated with high morbidity. In this patient population, bleeding diathesis represents a significant challenge in clinical management.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/cvja.co.za\/journal\/cvja-2026-050\/","og_locale":"en_US","og_type":"article","og_title":"Examination of acquired coagulopathy in patients with aortic stenosis - Cardiovascular Journal of Africa","og_description":"Aortic stenosis (AS) is one of the cardiovascular diseases with an increasing prevalence and is associated with high morbidity. In this patient population, bleeding diathesis represents a significant challenge in clinical management.","og_url":"https:\/\/cvja.co.za\/journal\/cvja-2026-050\/","og_site_name":"Cardiovascular Journal of Africa","article_published_time":"2026-10-19T07:51:41+00:00","author":"Jaco Moolman","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Jaco Moolman","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/cvja.co.za\/journal\/cvja-2026-050\/","url":"https:\/\/cvja.co.za\/journal\/cvja-2026-050\/","name":"Examination of acquired coagulopathy in patients with aortic stenosis - Cardiovascular Journal of Africa","isPartOf":{"@id":"https:\/\/cvja.co.za\/journal\/#website"},"datePublished":"2026-10-19T07:51:41+00:00","author":{"@id":"https:\/\/cvja.co.za\/journal\/#\/schema\/person\/6bf8a30a039e93fd8112db707affb920"},"description":"Aortic stenosis (AS) is one of the cardiovascular diseases with an increasing prevalence and is associated with high morbidity. In this patient population, bleeding diathesis represents a significant challenge in clinical management.","breadcrumb":{"@id":"https:\/\/cvja.co.za\/journal\/cvja-2026-050\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/cvja.co.za\/journal\/cvja-2026-050\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/cvja.co.za\/journal\/cvja-2026-050\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/cvja.co.za\/journal\/"},{"@type":"ListItem","position":2,"name":"Examination of acquired coagulopathy in patients with aortic stenosis"}]},{"@type":"WebSite","@id":"https:\/\/cvja.co.za\/journal\/#website","url":"https:\/\/cvja.co.za\/journal\/","name":"Cardiovascular Journal of Africa","description":"The Cardiovascular Journal of Africa is a peer-reviewed medical journal publishing leading research in cardiovascular health across Africa since 1990","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/cvja.co.za\/journal\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/cvja.co.za\/journal\/#\/schema\/person\/6bf8a30a039e93fd8112db707affb920","name":"Jaco Moolman","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/cvja.co.za\/journal\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/454c6719ed785bfd40e036ca3c3ac3347c56b4a99902df8beb62d882b1e6967f?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/454c6719ed785bfd40e036ca3c3ac3347c56b4a99902df8beb62d882b1e6967f?s=96&d=mm&r=g","caption":"Jaco Moolman"},"url":"https:\/\/cvja.co.za\/journal\/author\/jacodesignconnection-co-za\/"}]}},"_links":{"self":[{"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/posts\/5767","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/comments?post=5767"}],"version-history":[{"count":1,"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/posts\/5767\/revisions"}],"predecessor-version":[{"id":5769,"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/posts\/5767\/revisions\/5769"}],"wp:attachment":[{"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/media?parent=5767"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/categories?post=5767"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/tags?post=5767"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}