title: Percutaneous coronary intervention in a patient with congenital factor XI deficiency and acquired inhibitor.
abstract: BACKGROUND
  Factor XI deficiency has been associated with bleeding diathesis mostly secondary to trauma and post-operatively depending on the severity of deficiency. Cases with factor XI deficiency having undergone cardiac surgery and coronary intervention after appropriate replacement therapy have been reported in the past. The presence of inhibitor in factor XI deficiency poses a hematological challenge and literature regarding coronary intervention in such patients is limited. Immunosuppressive therapy, plasma exchange and factor VII product transfusions have been used prior to cardiac interventions in few such reported cases.
  
  
  METHODS
  We report our approach in such a case of Percutaneous Transluminal Coronary Angioplasty in a 72-year-old male of Jewish origin who has congenital factor XI deficiency complicated with acquired inhibitor.
  
  
  RESULTS
  In some cases, the acuity of the coronary syndrome may mandate immediate coronary intervention. However, patient's history of factor XI deficiency and acquired inhibitor pose a major dilemma of further course of action. We performed percutaneous balloon angioplasty in this case with no anti-coagulant and with favorable outcome.
  
  
  CONCLUSIONS
  Under these circumstances of significant coagulation disorder and based on the case report, we recommend that balloon angioplasty be undertaken with no additional anti-coagulation other than Aspirin.
authors.affiliation: Division of Cardiology, SUNY Downstate Medical Center, Brooklyn, NY 11203-2098 , USA.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Mungee
authors.forename: Reuven
authors.initials: R
authors.lastname: Lapin
authors.forename: Erdal
authors.initials: E
authors.lastname: Cavusoglu
authors.forename: Luther T
authors.initials: LT
authors.lastname: Clark
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Marmur
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005173:Factor XI Deficiency / Q000097:blood / Q000151:congenital*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*