Nevertheless, previous research has linked anemia before valve replacement to an increased risk of periprocedural bleeding.31 Even though the von Willebrand factor increases after valve replacement, it could take several days before normal levels are achieved.32 The use of heparin during the procedure, while the characteristic bleeding diathesis of Heyde syndrome is still present, could result in a surplus of bleeding. This evidence concerns the gene VWF and anemia (phenotype).