Current Therapeutic Approach to Atrial Fibrillation in Patients with Congenital Hemophilia

Bădescu, Magda; Bădulescu, Oana Viola; Butnariu, Lăcrămioara Ionela; Floria, Mariana; Ciocoiu, Manuela; Costache, Irina‐Iuliana; Popescu, Dan; Bratoiu, Ioana; Buliga-Finis, Oana Nicoleta; Rezuş, Ciprian

doi:10.3390/jpm12040519

Cited by 6 publications

(8 citation statements)

References 138 publications

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“…In the future we will adapt our approach to reduce the bleeding risk for those patients even further, considering these cutoffs before starting any long-term anticoagulation [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and Feasibility of Catheter Ablation Procedures in Patients with Bleeding Disorders

Feher

Saguner

Kirstein

et al. 2022

JCM

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Aims/Objectives: Patients with bleeding disorders are a rare and complex population in catheter ablation (CA) procedures. The most common types of bleeding disorders are von Willebrand disease (VWD) and hemophilia A (HA). Patients with VWD or HA tend to have a higher risk of bleeding complications compared to other patients. There is a lack of data concerning peri- and postinterventional coagulation treatment. We sought to assess the optimal management of patients with VWD and HA referred for catheter ablation procedures. Methods and Results: In this study, we analyzed patients with VWD or HA undergoing CA procedures at two centers in Germany and Switzerland between 2016 and 2021. Clotting factors were administered in conjunction with hemostaseological recommendations. CA was performed as per the institutional standard. During the procedure, unfractionated heparin (UFH) was given intravenously with respect to the activated clotting time (ACT). Primary endpoints included the feasibility of the procedure, bleeding complications, and thromboembolic events during the procedure. Secondary endpoints included bleeding complications and thromboembolic events up to one year after catheter ablation. A total of seven patients (three VWD Type I, one VWD Type IIa, three HA) underwent 10 catheter ablation procedures (pulmonary vein isolation (PVI): two × radiofrequency (RF), one × laser balloon (LB), one × cryoballoon (CB); PVI + cavotricuspid isthmus (CTI): one × RF; PVI + left atrial appendage isolation (LAAI): one × RF; Premature ventricular contraction (PVC): three × RF; Atrioventricular nodal reentrant tachycardia (AVNRT): one × RF). VWD patients received 2000–3000 IE Wilate i.v. 30 to 45 min prior to ablation. Patients with HA received 2000–3000 IE factor VIII before the procedure. All patients undergoing PVI received UFH (cumulative dose 9000–18,000 IE) with a target ACT of >300 s. All patients after PVI were started on oral anticoagulation (OAC) 12 h after ablation. Two patients received aspirin (acetylsalicylic acid; ASA) for 4 weeks after the ablation of left-sided PVCs. No anticoagulation was prescribed after slow pathway modulation in a case with AVNRT. No bleeding complications or thromboembolic events were reported. During a follow-up of one year, one case of gastrointestinal bleeding occurred following OAC withdrawal after LAA occlusion. Conclusions: After the substitution of clotting factors, catheter ablation in patients with VWD and HA seems to be safe and feasible.

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“…In the future we will adapt our approach to reduce the bleeding risk for those patients even further, considering these cutoffs before starting any long-term anticoagulation [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and Feasibility of Catheter Ablation Procedures in Patients with Bleeding Disorders

Feher

Saguner

Kirstein

et al. 2022

JCM

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“… 63 The rationale for this approach lies in the fact that more than 90% of emboli originate in the left atrial appendage. 64 However, in order to prevent device-related thrombosis, antithrombotic treatment is required at least until complete endothelization of the device surface has occurred, usually for at least 3 months. 65 Factor concentrate prophylaxis is required during this antithrombotic treatment ( Table 1 ).…”

Section: Management Of Cardiovascular Diseasesmentioning

confidence: 99%

How we manage cardiovascular disease in patients with hemophilia

Franchini

Focosi²,

Mannucci

2023

haematol

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With the striking advances in hemophilia care that materialized particularly in the last two decades, an increasing number of persons with hemophilia (PWH) have achieved a quality of life and life expectancy very close to that of unaffected individuals. With aging, a growing number of PWH develop age-related co-morbidities, including cancer and cardiovascular disease. The latter (particularly coronary artery disease and atrial fibrillation) represent a new challenge for the hemophilia treatment centers because their management implies a delicate balance between the thrombotic risk and bleeding tendency, that is further enhanced by the concomitant use of antithrombotic agents. Because evidence from clinical trials is lacking, the management of PWH with cardiovascular diseases is mostly based on expert opinions, personal experiences and the adaptation of the evidence stemming from studies on people without hemophilia. In this article, we focus on how to manage coronary artery disease and atrial fibrillation.

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“…It has been postulated that PWH may be protected from acute coronary syndrome and cardiovascular mortality through increased plaque stability and reduced thrombin generation following plaque rupture 4 . The other significant source of arterial thrombosis is atrial fibrillation, which hemophilia does not protect against, but FVIII or FIX deficiency intuitively reduces its thrombogenic risk 5 …”

Section: Basal Factor VIII or Ix Levels Duration Of Antithrombotic Tr...mentioning

confidence: 99%

mentioning

confidence: 99%

“…4 The other significant source of arterial thrombosis is atrial fibrillation, which hemophilia does not protect against, but FVIII or FIX deficiency intuitively reduces its thrombogenic risk. 5 PWH are less likely to develop venous thrombo-embolic disease (VTED) due to the role of coagulation factors in their occurrence. 6 However, major orthopedic surgery in intensively substituted patients can increase the risk of VTED.…”

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confidence: 99%

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