title: Presentation and management of acute coronary syndromes among adult persons with haemophilia: results of an international, retrospective, 10-year survey.
abstract: Sparse data are available on presentation and management of acute coronary syndromes (ACS), including unstable angina and non-ST- and ST-elevation myocardial infarction, among persons with haemophilia (PWH). The aim of this study was to determine demographics, bleeding disorder characteristics, cardiovascular risk factors (CRFs), interventions, haemostatic protocol, revascularization outcomes and complications among PWH with ACS. Members of an international consortium comprising >2000 adult PWH retrospectively completed case report forms for episodes of ACS in a >10-year follow-up period (2003-2013). Twenty ACS episodes occurred among 19 patients [rate, 0.8% (95% CI 0.4, 1.2)]. Seven patients (37%) were aged <50 years; 10 (53%) had ≥3 CRFs. In 5/20 episodes (25%), the initial ACS management protocol was altered because of the bleeding disorder. None of the eight patients with severe haemophilia underwent coronary artery bypass grafting (CABG), compared with 54.5% of patients with non-severe disease (P = 0.02). Revascularization with percutaneous coronary intervention (PCI) or CABG was rated successful in 13/13 cases, with no excessive bleeding during initial management. During chronic exposure to antiplatelet agents, secondary haemophilia prophylaxis was more prevalent in patients with severe haemophilia compared with non-severe haemophilia (85.7% vs. 30%, P = 0.05). No ACS-related deaths occurred during initial management, but one patient with severe haemophilia A died of undetermined cause 36 months after the ACS event while on aspirin therapy. ACS occurs even among relatively younger PWH, typically in association with multiple CRFs. Revascularization with PCI/CABG is feasible, and antiplatelet agents plus secondary prophylaxis appears to be well tolerated in selected PWH with ACS.
authors.affiliation: Penn Comprehensive Hemophilia and Thrombosis Program, Philadelphia, PA, USA.
authors.forename: P F
authors.initials: PF
authors.lastname: Fogarty
authors.affiliation: Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: M E
authors.initials: ME
authors.lastname: Mancuso
authors.affiliation: Division of Hematology and Oncology, Hemophilia and Thrombosis Center, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: R
authors.initials: R
authors.lastname: Kasthuri
authors.affiliation: Munich Hemophilia Centre, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Bidlingmaier
authors.affiliation: Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: M
authors.initials: M
authors.lastname: Chitlur
authors.affiliation: Royal Free Hospital, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Gomez
authors.affiliation: Department of Haematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: P A
authors.initials: PA
authors.lastname: Holme
authors.affiliation: Queen's University, Kingston, ON, Canada.
authors.forename: P
authors.initials: P
authors.lastname: James
authors.affiliation: Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Kruse-Jarres
authors.affiliation: Faculty of Health Sciences, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
authors.forename: J
authors.initials: J
authors.lastname: Mahlangu
authors.affiliation: Regional University Hospital Carlos Haya, Malaga, Spain.
authors.forename: M E
authors.initials: ME
authors.lastname: Mingot-Castellano
authors.affiliation: Children's Hospital of Orange County, Orange, CA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Soni
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D001026:Coronary Artery Bypass; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000150:complications*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D038622:Internationality; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies
chemical_list: D005343:Fibrinolytic Agents; D006490:Hemostatics
keywords: acute coronary syndrome; antiplatelet therapy; cardiovascular disease; haemophilia; myocardial infarction; stent