Some patients with aortic stenosis have recurrent bleeding intotheir skin or gastrointestinal tract. Several studies suggestthat this bleeding is caused by an acquired defect in von Willebrandfactor and that replacement of the aortic valve restores thenormal structure of von Willebrand factor and restores normalhemostasis. However, we know little about the prevalence ofsymptomatic defects in von Willebrand factor in patients withaortic stenosis. In this issue of the Journal, Vincentelli andcolleagues (pages 343349) address this question and providenew information about the response of such hemostatic abnormalitiesto valve replacement.
From the Howard Hughes Medical Institute, Department of Medicine, Washington University School of Medicine, St. Louis.
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