How I treat patients with inherited bleeding disorders who need anticoagulant therapy.
Situations that ordinarily necessitate consideration of anticoagulation, such as arterial and venous thrombotic events and prevention of stroke in atrial fibrillation, become challenging in patients with inherited bleeding disorders such as hemophilia A, hemophilia B, and von Willebrand disease. There are no evidence-based guidelines to direct therapy in these patients, and management strategies that incorporate anticoagulation must weigh a treatment that carries a risk of hemorrhage in a patient who is already at heightened risk against the potential consequences of not treating the thrombotic event. In this paper, we review atherothrombotic disease, venous thrombotic disease, and atrial fibrillation in patients with inherited bleeding disorders, and discuss strategies for using anticoagulants in this population using cases to illustrate these considerations.
Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC.
Karlyn
0000-0002-9385-8705
K
Martin
Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC.
Nigel S
0000-0002-8930-4304
NS
Key
D000925:Anticoagulants / Q000627:therapeutic use*; D025861:Blood Coagulation Disorders, Inherited / Q000097:blood / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D008297:Male; D013927:Thrombosis / Q000097:blood / Q000188:drug therapy*
D000925:Anticoagulants