Cardiac catheterization and intervention in haemophilia patients: prospective evaluation of the 2009 institutional guideline

Abstract

Ageing haemophilia patients are increasingly confronted with ischaemic heart disease (IHD). Treatment is complex because of the delicate equilibrium between bleeding and thrombosis. In 2009, we developed an institutional guideline on how to treat IHD in this patient population. The aim of this study was to evaluate feasibility and safety of this guideline. Haemophilia patients who underwent coronary angiography or percutaneous coronary intervention between January 2009 and June 2012 were included in the current case series. Nine diagnostic or therapeutic cardiac catheterizations were performed in six haemophilia patients. One patient with moderate haemophilia B was included, whereas the other patients had mild haemophilia A. In six of nine procedures, access to the circulation was gained via the radial artery. Only bare-metal stents were implanted, after which dual antiplatelet treatment was given for at least 4 weeks. During cardiac catheterization/intervention and dual antiplatelet treatment, clotting factor levels were corrected. No thrombotic or clinically relevant bleeding complications occurred. In one patient, a low-titre inhibitor recurred 10 months after catheterization. In-stent restenosis was diagnosed in one patient. This case series indicates that treatment according to the guideline is feasible and safe. Furthermore, based on the case series and developments in new guidelines for non-haemophilic patients with IHD, some adjustments on the 2009 guideline are proposed.

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

“…Dual antiplatelet therapy was started after PCI in most cases, but there are also reports with DAPT including loading doses of clopidogrel before PCI . We found one case of a patient treated with a loading dose of prasugrel , and two cases with loading doses of ticagrelor , but thereafter DAPT consisting of ASA and clopidogrel was used during follow‐up. Factor substitution during the period of DAPT was performed in 21 of 28 (75%) patients.…”

“…The process of search and article selection is shown in Figure . Information for the present analysis was extracted from 29 articles (case reports and small case series) .…”

Presentation and management of acute coronary syndromes among adult persons with haemophilia: results of an international, retrospective, 10‐year survey

“…[17,18] Our data collection records details regarding the medical and interventional management of ACS, including haemostatic coverage strategies in the acute and in the chronic setting, which have been investigated to some extent previously [10,17]. [17,18] Our data collection records details regarding the medical and interventional management of ACS, including haemostatic coverage strategies in the acute and in the chronic setting, which have been investigated to some extent previously [10,17].…”

Old Age Medicine and Hemophilia

“…Recently, this guideline has been prospectively evaluated and has proven to be safe and feasible [30]. We developed a guideline for the management of cardiovascular disease in 2009.…”

“…Decision making in cardiovascular management in hemophilia[30]. Reproduced with permission of John Wiley and Sons.…”