Treatment of ischaemic heart disease in haemophilia patients: an institutional guideline

Schutgens, Roger E. G.; Tuinenburg, A.; Roosendaal, G.; Guyomi, S. Hoseyni; Mauser‐Bunschoten, E. P.

doi:10.1111/j.1365-2516.2009.02020.x

Cited by 72 publications

(154 citation statements)

References 23 publications

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“…The recommended serum level of FVIII is 0.8 U/I pre-catheterization until 48 hours post-catheterization. To achieve this level, the initial bolus of FVIII should be 40 U/kg infused over 30 minutes with a factor recovery assay done 15 minutes later and once peak level is achieved, maintenance is done by slow infusion at 20 U/kg every 12 hours for 48 hours (15). Bleeding is the most common complication especially if attempting femoral access compared to radial access.…”

Section: Patients With Inherited or Acquired High Risks Of Bleedingmentioning

confidence: 99%

“…Similar to hemophilia A, these patients have increased risk for hemorrhage and present with bleeding to joints or muscles due to mild trauma or occurring spontaneously. The recommendations for these patients are to transfuse factor IX at 80U/kg precatheterization to have a peak level of 0.8 U/I and once peak level is achieved, maintenance is with slow infusion at 20 U/kg every 12 hours for 48 hours post-catheterization (15).…”

Section: Patients With Inherited or Acquired High Risks Of Bleedingmentioning

confidence: 99%

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Percutaneous coronary intervention in patients with active bleeding or high bleeding risk

Nguyen

Nguyen²

2012

Anadolu Kardiyol Derg

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There is a lack of evidence from randomized clinical trials (RCT) supporting percutaneous coronary intervention (PCI) in patients with high bleeding risk or active bleeding. The management decisions are based on extrapolation of subgroups data in RCTs or experts' opinions. Bleeding in the peri-PCI period also increases mortality. In general, PCI can be performed if bleeding can be stopped by mechanical means (compressing or ligating the artery) and the patient can tolerate 4 hours of anticoagulant without further bleeding. For patient with acquired or inherited high risk of bleeding, anecdotal reports showed that either unfractionated heparin or bivalirudin would be acceptable for PCI. For patients on chronic oral anticoagulants, PCI could be performed without new antithrombotic therapy if the international ratio (INR) is between 2 and 3. Antiplatelet therapy would be needed if new thrombi are detected at the index artery. Ultimately, the decision to perform PCI or treat the patient conservatively must be managed on a case-by-case basis. If the benefits outweigh the risk, then the patient can undergo PCI. ( Review Derleme 165ÖZET Kanama riski yüksek veya aktif kanaması olan hastalarda perkütan koroner girişimi (PKG) destekleyen randomize klinik çalışmalardan (RKÇ) elde edilen kanıt eksikliği vardır. Takip kararları RKÇ'lerdeki subgrup analizine veya uzman görüşlerine dayanmaktadır. Kanama peri-PKG dönemdeki mortaliteyi de artırmaktadır. Genel olarak, kanama mekanik yöntemlerle (sıkıştırma ya da arterin bağlanması) durdurulabilecekse ve hastanın daha fazla kanaması olmadan antikoagülanı 4 saat tolere edebilecekse, PKG gerçekleştirilebilir. Edinsel veya kalıtsal kanama riski yüksek olan hasta için, anekdot raporları ya anfraksiyone heparin veya bivalirudinin PKG için kabul edebileceğini gösterdi. Oral antikoagülanları kronik alan hastalar için, uluslararası normalleştirme oranı (UNO) 2 ve 3 arasında ise PKG yeni antitrombotik tedavi olmaksızın PKG yapılabilmektedir. Belirlenen arterde eğer yeni trombüs tespit edilirse, antitrombosit tedavi gerekli olmalıdır. Sonuçta, PKG gerçekleştirmek veya konservatif hasta tedavisi kararı her bir olgu için ayrı ayrı takibi gerektirir. Yararları risklerinden fazla ise o zaman hastaya PKG uygulanabilir. (Anadolu Kardiyol Derg 2013; 13: 165-70) Anahtar kelimeler: Perkütan koroner girişimler, kanama, ST-segment yükselmeli miyokart enfarktüsü

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Section: Patients With Inherited or Acquired High Risks Of Bleedingmentioning

confidence: 99%

Section: Patients With Inherited or Acquired High Risks Of Bleedingmentioning

confidence: 99%

Percutaneous coronary intervention in patients with active bleeding or high bleeding risk

Nguyen

Nguyen²

2012

Anadolu Kardiyol Derg

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“…22 Schutgens et al and Mannucci et al underline the necessity to correct clotting factor deficiency in patients with hemophilia before performing a PCI or arterial angiography. 23,24 They recommend a target maximum level of 0.8 UL before PCI, and up to 48 hours after PCI, because a higher level can lead to hypercoagulability and the formation of an occlusive thrombus. Lim et al reported a study which included eight hemophiliacs.…”

Section: The Necessity Of Screening and Risk Of Invasive Investigatiomentioning

confidence: 99%

Noninvasive Assessment of Coronary Arteries in Patients with Hematologic Disorders

Lázár¹,

Oltean²,

Jáni³

et al. 2017

Journal of Interdisciplinary Medicine

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Hematological conditions and their treatments have an increased risk of cardiovascular events, and invasive interventions have a higher risk of periprocedural complications in this group of patients. The aim of this review was to evaluate the risk of invasive interventions in patients with hematologic disorders and to underline the role of noninvasive cardiovascular screening in patients with hematological disorders such as Hodgkin and non-Hodgkin lymphoma, anemia, hemophilia, thrombocythemia, polycythemia vera, and leukemia. Based on present knowledge in the field, our opinion is that the screening of patients with hematological diseases is very important to reduce the morbidity and mortality due to cardiovascular events. Noninvasive assessments are suitable for this purpose with a significantly lower risk compared to invasive interventions.

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“…33,44,45 The long-term use of low-dose aspirin in patients with mild or moderate hemophilia has been proposed, but extended use in patients with severe hemophilia may be difficult, even with factor prophylaxis and close monitoring for bleeding. 44 The use of warfarin has generally not been recommended.…”

Section: Cardiovascular Diseasementioning

confidence: 99%

“…Factor replacement to maintain a trough plasma factor level of at least 30 U/dL for the duration of the antiplatelet therapy has been recommended. 33,44 Close laboratory monitoring of factor levels periprocedurally, perioperatively, and during the use of anticoagulants and/or antiplatelet agents is required.…”

Section: Cardiovascular Diseasementioning

confidence: 99%

The Aging Patient with Hemophilia: Complications, Comorbidities, and Management Issues

Philipp

2010

Hematology

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Improvements in hemophilia care and antiviral treatments have resulted in increases in median life expectancy for persons with congenital hemophilia A and B. Currently, 2% of hemophilia A and B patients surveyed in US comprehensive hemophilia treatment centers are 65 years of age or older and 15% are 45 years or older. Many of the complications of hemophilia, including intracranial hemorrhage, joint disease, and inhibitor development, increase with increasing age. Hepatocellular carcinoma and end-stage liver disease are increasing in the older hemophilia population due to infection with hepatitis C (HCV) and HCV/HIV coinfection. Older hemophilia patients also now face the same medical conditions associated with aging in the general population, including cardiovascular disease and cancer. Complex hemostatic management, sometimes in conjunction with antithrombotic management, with extensive cross-specialty clinical and laboratory coordination may be required for the care of the older hemophilia patient. Because elderly hemophilia patients currently represent a small portion of the overall hemophilia population, there is little in the way of clinical data to guide recommendations. Registry databases and cooperative group studies are needed for the development of evidence-based guidelines for the older hemophilia population, which is anticipated to expand in the future.

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Treatment of ischaemic heart disease in haemophilia patients: an institutional guideline

Cited by 72 publications

References 23 publications

Percutaneous coronary intervention in patients with active bleeding or high bleeding risk

Percutaneous coronary intervention in patients with active bleeding or high bleeding risk

Noninvasive Assessment of Coronary Arteries in Patients with Hematologic Disorders

The Aging Patient with Hemophilia: Complications, Comorbidities, and Management Issues

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