Coronary Artery Bypass Surgery, Angioplasty and Long Term Anti-Platelet Treatment in a Type B Hemophilia Patient

Pesaro, Antônio Eduardo Pereira; Gaz, Marcus Vinicius Burato; Karbstein, Ralf; Perin, Marco Antônio; Serrano, Carlos; D'Amico, E B

doi:10.1590/s1807-59322009000800019

Cited by 13 publications

(13 citation statements)

References 5 publications

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“…Pesaro et al [12] reported OPCAB in a patient with severe haemophilia B using factor IX replacement. No antiplatelet agent was used, and six months later the patient was diagnosed with vein graft occlusion at angiography.…”

Section: Resultsmentioning

confidence: 99%

Do patients with haemophilia undergoing cardiac surgery have good surgical outcomes?

Rossi

Jayaram

Sayeed

2011

Interactive CardioVascular and Thoracic Surgery

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A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether patients with haemophilia undergoing cardiac surgery have good surgical outcomes. Haemophilia A and haemophilia B are sex-linked recessive inherited diseases affecting males only, with females acting as carriers. The conditions result in various degrees of factor VIII or factor IX deficiency, respectively. The life expectancy of haemophilia patients is increasing and now approaches that of the general male population, and they are confronted with age-related co-morbidity, including ischaemic cardiovascular disease. Replacement of the deficient factor (VIII for haemophilia A and IX for haemophilia B) is the cornerstone of treatment; other therapeutic options include tranexamic acid, desmopressin and aprotinin. Recently, the advent of recombinant factor VIII and IX has eliminated the infective risk of using factor concentrates, such as prothrombin complex concentrate or fresh frozen plasma. A total of 84 papers were found using the reported search criteria, and out of this 25 papers, selected with reference to a more modern date range, provided the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results were tabulated. We conclude that there is lack of good-quality evidence and that, in all probability, these papers are subject to publication bias as poor outcomes are unlikely to have been reported. However, all the reported series showed that good outcomes are possible in this specific subgroup of patients given the correct approach. The data accrued from these studies (a total of 30 adults and three children) suggest that routine cardiac surgery can be performed safely in patients with haemophilia, with minimal morbidity and mortality. We identified the following key points to achieve this result: a team approach, a factor replacement protocol and perioperative monitoring of factor levels. Intraoperative plasma factor levels can be easily measured before heparin and after protamine sulphate administration, whereas during cardiopulmonary bypass this will require a chromogenic method. Exposure to factor concentrates early in the life might predispose a patient with severe haemophilia to the development of inhibitors. Moreover, the absence of inhibitors should be confirmed before any surgical procedure.

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Section: Resultsmentioning

confidence: 99%

Do patients with haemophilia undergoing cardiac surgery have good surgical outcomes?

Rossi

Jayaram

Sayeed

2011

Interactive CardioVascular and Thoracic Surgery

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“…The reported complications consisted of post‐pericardiotomy syndrome, hemopericardium and tamponade, aortic dissection, atrial fibrillation, gastrointestinal bleeding, and hemarthrosis . Off‐pump CABG was performed only in three patients with severe hemophilia . Two cases were uneventful and one case was complicated with early vein‐graft occlusion (Table ) …”

Section: Review Of the Literaturementioning

confidence: 99%

“…Reference lists of original articles were also reviewed. In addition, an extensive search 25 Chronic viral infections with known atheromatic activity including chronic hepatitis C virus 10,16 and human immunodeficiency virus 9,12 were also reported.…”

Section: Review Of the Literaturementioning

confidence: 99%

Replacement therapy for coronary artery bypass surgery in patients with hemophilia A and B

Kanellopoulou

Nomikou

2018

J Card Surg

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There are only a few cases of patients with hemophilia A and B who have undergone coronary artery bypass surgery. High levels of replacement therapy with factor concentrate either with bolus or continuous infusion are usually required pre-operatively and during the first post-operative days in order to maintain the coagulation deficient factor levels greater than 80% of normal. Heparinization during cardiopulmonary bypass appears to be safe and intra-operative blood salvage using cell saver techniques reduce the need for transfusions.

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“…Incidence of venous thromboembolism in patients undergoing cardiac surgery is uncertain and the need of thromboprophylaxis controversial, in our case the haemophilic patient was still to very high risk of bleeding, according to the ACCP recommendation [10], but conversely with reported by Tang et al [1], where some patients who underwent valve surgery, received thromboprophylaxis with low molecular weight heparin, the physicians decided, to prevent thromboembolism, only the use of intermittent pneumatic compression followed by graduated compression stockings. According to international guidelines [10] that recommend to all patients undergoing CABG indefinite use of aspirin, still in our case, given the patient's age, the recent surgery, the level of FVIII increasing by daily infusion, which may cause bypass thrombosis and the fact that several studies have demonstrated that hemophilia does not protect against the risk of cardiac disease [1][2][3], it was decided to treat the patient with low dose of ASA.…”

Section: Discussionmentioning

confidence: 99%

“…For several years it was believed that patients with hemophilia were protected against these diseases, but although some studies showed the low mortality for coronary vessel diseases in haemophilic patients, it was also shown that the reduced level of FVIII in hemophilia A people can not protect against heart disease. Today the life expectancy in the hemophilia people is similar to the non-haemophilics and age-related cardiovascular disorders to become more prevalent [1][2][3]. Cardiac surgeries are considered a very high risk for patient with hemophilia because of the need of heparinization and extracorporeal circulation [1].…”

Section: Introductionmentioning

confidence: 99%

Successful double bypass in a patient with severe hemophilia A: a case report

Barillari

Pasca

Erice³

et al. 2011

J Thromb Thrombolysis

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Life expectancy in the hemophilia people is similar to the non-haemophilics and age-related cardiovascular disorders to become more prevalent, but cardiac surgery is considered a very high risk for these patients. In this article we report the successful cardiac double bypass internal mammary artery--coronary artery in a patient with severe hemophilia A. (FVIII<1%; missense mutation: exon 16, c.5508 G>A (domain A3), p.Trp1817Stop). Continuous infusion of rFVIII B-domain deleted was used to control haemostasis during surgery and in post-operative period. There was no bleeding complications and the patient did not need to receive transfusion of red blood cells or platelets.

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Coronary Artery Bypass Surgery, Angioplasty and Long Term Anti-Platelet Treatment in a Type B Hemophilia Patient

Cited by 13 publications

References 5 publications

Do patients with haemophilia undergoing cardiac surgery have good surgical outcomes?

Do patients with haemophilia undergoing cardiac surgery have good surgical outcomes?

Replacement therapy for coronary artery bypass surgery in patients with hemophilia A and B

Successful double bypass in a patient with severe hemophilia A: a case report

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