Management of antithrombotic therapy for acute coronary syndromes and atrial fibrillation in patients with hemophilia

Expert Opinion on Pharmacotherapy
Pier M Mannucci

Abstract

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. 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. 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.

References

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Jul 9, 2010·Haemophilia : the Official Journal of the World Federation of Hemophilia·P M Mannucci, E P Mauser-Bunschoten

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Citations

Feb 18, 2015·Haemophilia : the Official Journal of the World Federation of Hemophilia·P F FogartyUNKNOWN Global Emerging Hemophilia Panel (GEHEP)
Mar 25, 2015·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Carlos Aguilar
Nov 30, 2013·Haemophilia : the Official Journal of the World Federation of Hemophilia·J PocoskiT J Humphries
Jun 12, 2013·Thrombosis Research·Guillaume CaylaJean-François Schved
Dec 2, 2014·Cardiology in Review·Victor A FerrarisGilbert C White
Apr 9, 2017·Seminars in Cardiothoracic and Vascular Anesthesia·Patrick OdonkorKenichi A Tanaka
Aug 2, 2017·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Matthew J ReilleyPatrick F Fogarty
Nov 22, 2017·Drugs & Aging·Massimo Franchini, Pier Mannuccio Mannucci
Sep 13, 2017·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Christian BoehnelMicha T Maeder
Mar 23, 2013·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Carlos Aguilar
Oct 4, 2017·British Journal of Anaesthesia·E R StraussK A Tanaka

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