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Cohort studyInternational journal of cardiology · 2026

Aortic stenosis severity gradient and gastrointestinal bleeding: Pathophysiological mechanisms, epidemiological evidence, and rationale for a gradient-stratified retrospective study.

Sheeza Nawaz, Adishwar Rao, Muhammad Aslam Khan … Edo Kaluski

GastroenterologyCohort study

Severe aortic stenosis is associated with a higher rate of major bleeding.

Aortic stenosis severity gradient and gastrointestinal bleeding: Pathophysiological mechanisms, epidemiological evidence, and rationale for a gradient-stratified retrospective study.

Sheeza Nawaz et al. · International journal of cardiology · 2026

Background

Aortic stenosis (AS) is the most prevalent valvular heart disease in aging Western populations and is pathophysiologically linked to gastrointestinal (GI) bleeding through acquired von Willebrand syndrome (aVWS).

Methods

We conducted a narrative synthesis of peer-reviewed literature from PubMed, Embase, and Cochrane databases examining AS severity, von Willebrand factor (VWF) abnormalities, GI bleeding outcomes, and reversibility after valve replacement.

Results

severe aortic stenosis has a much higher rate of serious bleeding than mild disease

HR 3.59 (95% CI 1.56 to 8.29)

CI excludes the null - significant

More results

High shear stress at the stenotic valve cleaves high-molecular-weight (HMW) VWF multimers via ADAMTS-13, creating hemostatic deficiency compounded by GI angiodysplasia.

A consistent inverse correlation between transvalvular gradient and HMW multimer levels is demonstrated across multiple cohorts (r = -0.40 to -0.64).

More results

GI bleeding cessation occurs in 73% and aVWS recovery in 86-92% of patients after valve replacement.

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Conclusion · 1 of 2

Direct quantification of GI bleeding incidence across the full transvalvular gradient spectrum as a continuous variable remains an important evidence gap.

Conclusion · 2 of 2

A gradient-stratified retrospective cohort study is warranted, with implications for risk stratification, timing of valve intervention, and bleeding prophylaxis.

Post

Aortic stenosis severity gradient and gastrointestinal bleeding: Pathophysiological mechanisms, epidemiological evidence, and rationale for a gradient-stratified retrospective study.

Severe aortic stenosis is associated with a higher rate of major bleeding.

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