title: Management of antithrombotic therapy for acute coronary syndromes and atrial fibrillation in patients with hemophilia.
abstract: BACKGROUND
  Patients with hemophilia now have a life expectancy very close to that of the unaffected male population and, hence, are at risk of developing the classic age-related morbidities, i.e., cardiovascular diseases. The peculiarity of the management of these diseases in hemophilia is that antithrombotic drugs impinge on the already compromised hemostasis of these lifelong bleeders.
  
  
  METHODS
  This opinion article outlines the strategies we have developed, based on our clinical experience, for the antithrombotic treatment of two common cardiovascular diseases - acute coronary syndromes and chronic atrial fibrillation - in patients with hemophilia A and B.
  
  
  CONCLUSIONS
  In the absence of specific evidence-based guidelines for patients with coagulation defects, antithrombotic treatment is currently based on expertise and adaptation of the guidelines developed for non-hemophilic patients. Replacement therapy should be tailored with the deficient coagulation factor so as to control the increased risk of bleeding inherent in the use of antiplatelet and anticoagulant drugs.
authors.affiliation: IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Via Pace 9, 20122 Milano, Italy. pmmannucci@libero.it
authors.forename: Pier Mannuccio
authors.initials: PM
authors.lastname: Mannucci
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy* / Q000517:prevention & control; D001281:Atrial Fibrillation / Q000097:blood / Q000188:drug therapy* / Q000517:prevention & control; D019468:Disease Management; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006467:Hemophilia A / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D006801:Humans
chemical_list: D005343:Fibrinolytic Agents