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Heghine Khachatryan: When Vascular Fragility Defines Risk – Rethinking Hemostasis in LDS
Heghine Khachatryan/LinkedIn
Apr 10, 2026, 01:19

Heghine Khachatryan: When Vascular Fragility Defines Risk – Rethinking Hemostasis in LDS

Heghine Khachatryan, Editor-in-Chief of Hemostasis Today, Head of Hemophilia and Thrombosis Center at Yeolyan Hematology and Oncology Center, shared a post on LinkedIn:

“When Vascular Fragility Defines Risk: Rethinking Hemostasis in Loeys – Dietz Syndrome

Loeys – Dietz syndrome (LDS) is widely recognized as a connective tissue disorder with aggressive vascular involvement, driven by mutations in the TGF-β signaling pathway.

Yet, beyond aneurysms and dissections, an important question remains insufficiently addressed:

Do we fully understand the hemostatic and perioperative risks in these patients?

Clinical Reality

Patients with LDS often present with:

  • Marked arterial tortuosity and aneurysmal disease
  • Extreme vascular fragility
  • Need for repeated surgical or endovascular interventions

However, intraoperative and postoperative courses may be complicated by:

  • Unexpected bleeding
  • Tissue friability
  • Challenging hemostasis despite ‘normal’ routine labs

The Hidden Hemostasis Dimension

While LDS is not classically categorized as a coagulation disorder, several mechanisms may be clinically relevant:

  • Structural vessel wall defects – mechanical bleeding tendency
  • Altered extracellular matrix – impaired vascular integrity
  • Possible endothelial dysfunction
  • Limited evidence regarding platelet – vessel interaction abnormalities

Key Questions for Experts

  • Should LDS be considered a functional bleeding-risk condition, even with normal PT/aPTT?
  • Is there value in extended hemostasis testing (platelet function, viscoelastic assays)?
  • How should we optimize perioperative hemostatic strategies?
  • Should antifibrinolytics (e.g., tranexamic acid) be used more proactively?
  • Do current surgical protocols sufficiently reflect vascular fragility biology?”

Heghine Khachatryan

More posts featuring Heghine Khachatryan on Hemostasis Today.

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