title: Acquired Hemophilia A May Be Associated with Ticagrelor Therapy in a 52-Year-Old Man After a Recent Percutaneous Transluminal Coronary Angioplasty.
abstract: We present a case report of a 52-year-old man who was hospitalized for right leg pain due to a relevant hemorrhagic effusion. He was on dual antiplatelet therapy (DAPT): acetylsalicylic acid and ticagrelor, a reversible P2Y12 receptor antagonist. Signs, symptoms, and laboratory blood tests led to the diagnosis of acquired hemophilia A (AHA). Ticagrelor therapy-associated AHA was hypothesized due to the fact that, before adding this drug, all laboratory and clinical examinations were repeatedly normal. Prednisone and cyclophosphamide treatment was started without DAPT interruption due to the high risk of stent thrombosis. After 10 days, prolonged activated partial thromboplastin time dropped from 107 to 49 seconds, the patient's factor VIII (FVIII) levels gradually normalized over the following few weeks, and FVIII inhibitor titer was negative. Recently, some reports have established a link between the development of AHA and treatment with clopidogrel, an irreversible P2Y12 receptor antagonist. However, to the best of our knowledge, this is the first time that a link between AHA and ticagrelor has been reported.
authors.affiliation: Emergency Department, Unit of Internal Medicine, Santa Croce Hospital, Moncalieri, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Pasquino
authors.affiliation: Department of Drug Science and Technology, University of Torino, Torino, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Canaparo
authors.affiliation: Emergency Department, Unit of Internal Medicine, Santa Croce Hospital, Moncalieri, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Capello
authors.affiliation: Emergency Department, Unit of Internal Medicine, Santa Croce Hospital, Moncalieri, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Deorsola
authors.affiliation: Emergency Department, Unit of Internal Medicine, Santa Croce Hospital, Moncalieri, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Perazzolo
authors.affiliation: Emergency Department, Unit of Internal Medicine, Santa Croce Hospital, Moncalieri, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Marengo
authors.affiliation: Department of Drug Science and Technology, University of Torino, Torino, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Serpe
keywords: acquired hemophilia A; factor VIII; percutaneous transluminal coronary angioplasty; platelet aggregation inhibitors; ticagrelor