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Catheter Cardiovasc Interv. 2018 Jul;92(1):1-15. doi: 10.1002/ccd.27255. Epub 2017 Sep 12.

Coronary angiography with or without percutaneous coronary intervention in patients with hemophilia-Systematic review.

Author information

1
Cardiology Department, Kantonsspital St. Gallen, Switzerland.
2
Center for Laboratory Medicine, Hemostasis and Hemophilia Center, St. Gallen, Switzerland.

Abstract

OBJECTIVES:

We aimed to summarize the evidence for periprocedural and long-term strategies to both minimize the bleeding risk and ensure sufficient anticoagulation and antiaggregation in hemophilia patients undergoing coronary angiography with or without percutaneous coronary interventions (PCI).

BACKGROUND:

Hemophilia patients undergoing coronary angiography and PCI are at risk of bleeding due to deficiency of the essential clotting factors VIII or IX combined with the need of peri-interventional anticoagulation and antiaggregation and dual antiplatelet therapy (DAPT) after PCI.

METHODS:

We report on a patient with moderate hemophilia B undergoing single-vessel PCI with administration of factor IX concentrate during the procedure and during the 1-month DAPT period. In addition, a systematic review of patients (n = 54, mean age 58 ± 10 years) with hemophilia A (n = 45, 83%) or B (n = 9, 17%) undergoing coronary angiography with or without PCI is presented.

RESULTS:

Peri-interventional factor substitution was performed in the majority (42 of 54, 78%) but not all patients. In 38 of 54 (70%) patients undergoing coronary angiography, PCI with balloon dilation (n = 5), bare metal (n = 31), or drug-eluting stents (n = 2) was performed. For PCI unfractioned heparin (n = 24), low molecular weight heparin (n = 2), bivalirudin (n = 4), or no periprocedural anticoagulation at all (n = 8) were used. PCI was successful in all cases. After stenting, the majority (28 of 33; 85%) was treated with DAPT (median duration 1 month). Major periprocedural bleeding episodes occurred in 3 of 54 (6%) patients. Bleeding during follow-up occurred in 11 of 54 (20%) patients.

CONCLUSIONS:

Coronary angiography and PCI in patients with hemophilia are effective and safe when applying individualized measures to prevent bleeding.

KEYWORDS:

anticoagulants/antithrombins; antiplatelet therapy; bleeding; coronary heart disease

PMID:
28895303
DOI:
10.1002/ccd.27255

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