Estimation of platelet function under high shear conditions to assist a rapid diagnosis of Heyde Syndrome

Loss of high molecular weight von Willebrand factor (VWF) multimers in patients suffering from aortic valve stenosis and gastrointestinal (GI) bleeding has been regarded as the missing link between aortic stenosis and bleeding. Electrophoretic analysis of VWF multimers is laborious and time-consuming. Further, determination of overall haemostatic competence rather than evaluation of restricted portions thereof may be advantageous. Accumulating evidence suggests that, recently developed in vitro and ex vivo platelet reactivity tests under high shear conditions mirror the in vivo situation. We report on a case of a 79-year-old man who presented with recurrent GI bleeding and severe aortic stenosis. Platelet function testing under high shear conditions using the commercially available cone and plate(let) analyser-Impact-R revealed significantly impaired shear dependent platelet function, suggesting VWD. This test offers an easy to use diagnostic tool to evaluate platelet function in suspected Heyde Syndrome thus leading to immediate tailored patient's management.