Department of Medicine, Massachusetts General Hospital, Boston, MA.
Harvard Medical School, Boston, MA.
Blood Adv. 2021 Oct 12;5(19):3850-3854. doi: 10.1182/bloodadvances.2021004810.
Heyde syndrome, the co-occurrence of aortic stenosis and bleeding gastrointestinal (GI) angiodysplasia, is managed with aortic valve replacement. However, severe bleeding and anemia can preclude safe use of the antiplatelet or anticoagulant therapy required for this intervention. We present a case of the novel and successful treatment of severe, refractory bleeding and transfusion dependence with antiangiogenic therapy in a patient with Heyde syndrome. After systemic bevacizumab was initiated, the patient achieved durable hemostasis with normalization of hemoglobin and liberation from red cell transfusion and dependence on iron infusion; aspirin therapy was successfully initiated where it had previously failed. This durable hemostasis facilitated her subsequent successful transcatheter aortic valve replacement. Plasma vascular endothelial growth factor levels, which were monitored during therapy, paradoxically rose after bevacizumab was initiated but normalized after it was discontinued. Given the angiogenic dysregulation of Heyde syndrome, systemic bevacizumab may be an effective and safe targeted therapy for managing refractory GI bleeding, which thereby facilitates antiplatelet therapy and aortic valve replacement in these challenging cases. Additional investigation into the therapeutic role of inhibiting angiogenesis as a hemostatic modality in Heyde syndrome is warranted.
海德综合征（Heyde syndrome）是指主动脉瓣狭窄和胃肠道（GI）出血性血管畸形同时存在，其治疗方法为主动脉瓣置换术。然而，严重的出血和贫血可能会妨碍这种干预所需的抗血小板或抗凝治疗的安全使用。我们报告了一例使用抗血管生成治疗海德综合征严重、难治性出血和输血依赖的新方法，获得了成功。在开始使用全身性贝伐珠单抗后，患者达到了持久的止血效果，血红蛋白恢复正常，摆脱了红细胞输血和铁输注的依赖；此前失败的阿司匹林治疗也成功启动。这种持久的止血为随后成功进行经导管主动脉瓣置换术提供了便利。在治疗过程中监测到的血浆血管内皮生长因子水平在开始使用贝伐珠单抗后反而升高，但在停药后恢复正常。鉴于海德综合征的血管生成失调，全身性贝伐珠单抗可能是治疗难治性胃肠道出血的一种有效且安全的靶向治疗方法，从而促进了这些具有挑战性病例中的抗血小板治疗和主动脉瓣置换术。因此，有必要进一步研究抑制血管生成作为海德综合征止血方式的治疗作用。
