Keywords
Coronary Artery Disease
Percutaneous Coronary Intervention
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Abstract
Objective: To report a successful case of hemophilia associated with coronary artery disease with an indication for percutaneous coronary intervention. Case details: This is a case report in which a male patient with hemophilia A was admitted to the emergency department with unstable angina. Catheterization revealed lesions in the anterior descending and circumflex coronary arteries. Due to the patient's risk of bleeding, the case was discussed with the hematology department. The decision was made to perform percutaneous coronary intervention, with preoperative administration of Factor VIII concentrate and continued replacement during hospitalization. The patient underwent dual therapy with ASA and ticagrelor for 1 month after surgery. Final considerations: cardiovascular diseases are difficult to manage in hemophiliac patients, due to the need to reconcile antithrombotic therapy with the high risk of bleeding. The lack of specific guidelines makes the management of these cases even more complex. For this reason, the evaluation is carried out jointly with cardiologists and hematologists.
References
AGEWALL S. Acute and stable coronary heart disease: different risk factors. European Heart Journal. 2008; 29(16): 1927-1929.
ALCANTARA ALM. Hemofilia: fisiopatologia e tratamento. Ciências da Educação e Saúde, 2019; 23.
BLANKE AOB, VARA MFF. Doença arterial coronariana e exercício físico: uma revisão de literatura. Cad Saúd e Desen. 2019; 14(8): 50-72.
CAMELO RM, et al. Escores de Risco Cardiovascular entre Adults Assintomáticos com Hemofilia. Arq. Bras. Cardiol. 2023; 9(120): e20230004.
DE RAUCOURT E, et al. Prevention and treatment of atherosclerosis in haemophilia - how to balance risk of bleeding with risk of ischaemic events. Eur J Haematol. 2015; 94(77): 23-29.
FAGHMOUS I, et al. Estimating the risk of thrombotic events in people with congenital hemophilia A using US claims data. Journal of Comparative Effectiveness Research. 2021; 10(18): 1323-1336.
FERRARIS VA, et al. Consensus Review of the Treatment of Cardiovascular Disease in People With Hemophilia A and B. Cardiology in Review. 2015; 23(2): 53-68.
FERREIRA AA, et al. Hemophilia A in Brazil - epidemiology and treatment developments. J Blood Med. 2014; 5(1): 175-184.
FRANCHINI M, et al. How we manage cardiovascular disease in patients with hemophilia. Journal List. 2023; 108(7): 1748-1757.
KROLL PNC e CARVALHO VN. Paciente hemofílico com doença arterial coronariana em pré-operatório de transplante de figado. J Transcat Intervent. 2022; 30: eA20210042.
MALE C, et al. Inhibitor incidence in an unselected cohort of previously untreated patients with severe haemophilia B: a PedNet study. Haematologica. 2021; 106(1): 123-129.
MANNUCCI PM e MAUSER BUNSCHOTEN EP. Cardiovascular disease in haemophilia patents: a contemporary issue. Haemophilia. 2010; 16(3): 58-66.
MEDEIROS TLF, et al. Mortalidade por infarto agudo do miocárdio. Rev enferm UFPE on line. 2018; 12(2): 565-572.
NICOLAU JC, et al. Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST. Arq. Bras. Cardiol. 2021; 1(117): 181-264.
PATHAK N, et al. Total knee arthroplasty in hemophilia A. Arthroplast Today. 2020; 6(1): 52-58.
RIBEIRA JPQS, et al. Aspectos genéticos da hemofilia A. Revisão de literatura. Brazil Journal of Development. 2021; 7(5): 48349-48362.
RICARDO IA, et al. Síndrome coronária aguda em doente com hemofilia A grave: decisões difíceis. Rev Port Card. 2021; 40(12): 985.e1-985.e5.
SCHUTGENS REG, et al. Treatment of ischaemic heart disease in haemophilia patients: an institutional guideline. Haemophilia. 2009; 15: 952-958.
SILVEIRA EL, et al. Prevalência e distribuição de fatores de risco cardiovascular em portadores de doença arterial coronariana no Norte do Brasil. Ver Fac Ciênc Méd Sorocaba. 2018; 3(20): 167-173.
SRIVASTAVA A, et al. WFH Guidelines for the Management of Hemophilia. Haemophilia. 2020; 26(6): 158.
VALGIMIGLI M, et al. Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk. N Engl J Med. 2021; 385: 1643-1655.
VRABIC ACA, et al. Dificuldades para enfrentar sozinho as demandas do tratamento: vivências do adolescente hemofílico. Acta Paulista de Enfermagem. 2012; 25(2): 204-210.
What Are Bleeding Disorders. National Heart, Lung and Blood Institute, National Institute of Health. Disponível em: https://www.nhlbi.nih.gov/health/bleeding-disorders. Acesso em 10 de agosto de 2023.
WIVIOTT SD, et al. Prasugrel versus Clopidogrel in Patients with Acute Coronary Syndromes. New England Journal of Medicine. 2007; 357(20): 2001-2015.
WONG ND. Epidemiological studies of CHD and the evolution of preventive cardiology. Nature Reviews Cardiology. 2014; 11(5): 276-289.