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Badulescu OV, Scripcariu DV, Badescu MC, Ciocoiu M, Vladeanu MC, Plesoianu CE, Bojan A, Iliescu-Halitchi D, Tudor R, Huzum B, Bararu Bojan I. Debates Surrounding the Use of Antithrombotic Therapy in Hemophilic Patients with Cardiovascular Disease: Best Strategies to Minimize Severe Bleeding Risk. Int J Mol Sci 2024; 25:7845. [PMID: 39063087 PMCID: PMC11277257 DOI: 10.3390/ijms25147845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/10/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Navigating through antithrombotic therapy in patients with both hemophilia and cardiovascular pathology presents a complex scenario with inherent challenges and opportunities. The presence of hemophilia, characterized by impaired blood clotting, adds a layer of complexity to the management of cardiovascular conditions requiring antiplatelet therapy and anticoagulation. Striking a delicate balance between the necessity for antithrombotic treatment to prevent cardiovascular events and the heightened risk of severe bleeding in individuals with hemophilia demands a nuanced and carefully considered approach. The challenges revolve around identifying an optimal therapeutic strategy that effectively mitigates cardiovascular risks without exacerbating bleeding tendencies. In hemophilic patients with cardiovascular disease, the decision to use antiplatelet therapy requires careful consideration of the individual's bleeding risk profile, considering factors such as the severity of hemophilia, history of bleeding episodes, and concurrent medications. The goal is to provide effective antithrombotic treatment while minimizing the potential for excessive bleeding complications. Conventional anticoagulants like warfarin pose difficulties due to their potential to increase the risk of bleeding. On the other hand, emerging options like novel direct oral anticoagulants (DOACs) present an opportunity, offering predictable pharmacokinetics and user-friendly administration. However, a comprehensive exploration of their safety and efficacy in hemophilic patients is imperative. Achieving the right equilibrium between preventing cardiovascular events and minimizing bleeding risk is pivotal in selecting the most effective therapeutic option for individuals with hemophilia and cardiovascular pathology. A multidisciplinary approach, integrating the expertise of hematologists and cardiologists, becomes essential to customize treatments and address the intricacies of this medical challenge.
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Affiliation(s)
- Oana-Viola Badulescu
- Department of Pathophysiology, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania; (O.-V.B.)
| | - Dragos Viorel Scripcariu
- Department of Surgical Sciences, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
| | - Minerva Codruta Badescu
- Department of Internal Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
| | - Manuela Ciocoiu
- Department of Pathophysiology, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania; (O.-V.B.)
| | - Maria Cristina Vladeanu
- Department of Pathophysiology, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania; (O.-V.B.)
| | - Carmen Elena Plesoianu
- Department of Internal Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
| | - Andrei Bojan
- Department of Surgical Sciences, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
| | - Dan Iliescu-Halitchi
- Department of Internal Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
| | - Razvan Tudor
- Department of Surgical Sciences, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
| | - Bogdan Huzum
- Department of Surgical Sciences, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
| | - Iris Bararu Bojan
- Department of Pathophysiology, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania; (O.-V.B.)
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2
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Ali AE, Becker RC. The foundation for investigating factor XI as a target for inhibition in human cardiovascular disease. J Thromb Thrombolysis 2024:10.1007/s11239-024-02985-0. [PMID: 38662114 DOI: 10.1007/s11239-024-02985-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 04/26/2024]
Abstract
Anticoagulant therapy is a mainstay in the management of patients with cardiovascular disease and related conditions characterized by a heightened risk for thrombosis. Acute coronary syndrome, chronic coronary syndrome, ischemic stroke, and atrial fibrillation are the most common. In addition to their proclivity for thrombosis, each of these four conditions is also characterized by local and systemic inflammation, endothelial/endocardial injury and dysfunction, oxidative stress, impaired tissue-level reparative capabilities, and immune dysregulation that plays a critical role in linking molecular events, environmental triggers, and phenotypic expressions. Knowing that cardiovascular disease and thrombosis are complex and dynamic, can the scientific community identify a common pathway or specific point of interface susceptible to pharmacological inhibition or alteration that is likely to be safe and effective? The contact factors of coagulation may represent the proverbial "sweet spot" and are worthy of investigation. The following review provides a summary of the fundamental biochemistry of factor XI, its biological activity in thrombosis, inflammation, and angiogenesis, new targeting drugs, and a pragmatic approach to managing hemostatic requirements in clinical trials and possibly day-to-day patient care in the future.
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Affiliation(s)
- Ahmed E Ali
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Richard C Becker
- Department of Internal Medicine, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA.
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Uminski K, Xu Y, Zahrai A, Hodgson A, Wang TF, Duffett L, Tinmouth A, Khalife R. Management strategies in persons with inherited haemophilia requiring antithrombotic therapy: A scoping review. Haemophilia 2024; 30:16-50. [PMID: 38087414 DOI: 10.1111/hae.14906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Thromboembolic events are increasingly reported in the aging haemophilia population. The purpose of this study was to understand current practices and identify knowledge and research gaps in the management of persons with haemophilia requiring antithrombotic therapy for cardiovascular disorders (CVD) or venous thromboembolism (VTE). METHODS We searched MEDLINE, EMBASE and Scopus for studies reporting on more than two patients with inherited haemophilia A or B, without inhibitors, requiring antithrombotic therapy for CVD or VTE. Data were extracted by two independent reviewers and analysed using descriptive statistics and narrative synthesis. RESULTS We included 32 studies reporting on 432 persons with haemophilia. Three themes described the observed practice variation: (1) Difficulty weighing competing bleeding and thrombotic risks; (2) Tensions in providing standards of care and minimizing bleeding risk; (3) Advocacy for individualized strategies and multidisciplinary care. Different management strategies were used to treat persons with haemophilia in the setting of thromboembolic events, such as avoiding or choosing lower intensity antithrombotic therapy, or procedural alternatives to antithrombotic therapy. Initiation or alteration in haemostatic therapies along with antithrombotic therapy were common strategies and reported in 30 studies. However, data on target factor levels and bleeding and thrombotic events were largely missing. DISCUSSION Our scoping review highlights unmet needs in the management of an aging population of persons with haemophilia with increasing prevalence of CVD and VTE. Management is inconsistent and divergent from those of non-haemophilic patients. Prospective data are needed to inform optimal and evidence-based management strategies of CVD and VTE in persons with haemophilia.
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Affiliation(s)
- Kelsey Uminski
- Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yan Xu
- Division of Hematology, Department of Medicine, University of Ottawa at the Ottawa Hospital, Ottawa, Ontario, Canada
| | - Amin Zahrai
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Amanda Hodgson
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Tzu-Fei Wang
- Division of Hematology, Department of Medicine, University of Ottawa at the Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lisa Duffett
- Division of Hematology, Department of Medicine, University of Ottawa at the Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alan Tinmouth
- Division of Hematology, Department of Medicine, University of Ottawa at the Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Roy Khalife
- Division of Hematology, Department of Medicine, University of Ottawa at the Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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4
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Badescu MC, Badulescu OV, Costache AD, Mitu O, Lupu VV, Dmour BA, Lupu A, Foia LG, Costache II, Rezus C. Atherosclerosis in Patients with Congenital Hemophilia: A Focus on Peripheral Artery Disease. Life (Basel) 2023; 13:2221. [PMID: 38004361 PMCID: PMC10672485 DOI: 10.3390/life13112221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Advances in the treatment of hemophilia have increased the life expectancy of this population and we are currently facing diseases associated with aging, including cardiovascular ones. Coronary atherosclerosis, with acute myocardial infarction as the most severe form of manifestation, has been recognized as part of the comorbidities of hemophiliacs. However, little is known about peripheral artery disease. Available data show that hemophiliacs have cardiovascular risk factors and atherosclerosis similar to the general population. Impaired thrombus formation and phenotype of atheroma plaque rather than the burden of atherosclerosis explains their lower cardiovascular mortality. Since the effect of traditional cardiovascular risk factors overpowers that of decreased coagulability and promotes the onset and progression of atherosclerotic lesions, screening for traditional cardiovascular risk factors and peripheral artery disease should be integrated into standard hemophilia care. There is evidence that invasive treatments and long-term antithrombotic therapy are generally safe, provided that coagulation factor levels are taken into account and replacement therapy is given when necessary.
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Affiliation(s)
- Minerva Codruta Badescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Oana Viola Badulescu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Hematology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Alexandru Dan Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
- Cardiovascular Rehabilitation Clinic, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ovidiu Mitu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
- Cardiology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Vasile Valeriu Lupu
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania (A.L.)
| | - Bianca-Ana Dmour
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
| | - Ancuta Lupu
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania (A.L.)
| | - Liliana Georgeta Foia
- Department of Biochemistry, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
| | - Irina-Iuliana Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
- Cardiology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
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5
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Mannucci PM, Agosti P, Lettino M. Guidance for the antithrombotic management of persons with haemophilia and cardiovascular disease. Haemophilia 2023; 29:1390-1393. [PMID: 37729476 DOI: 10.1111/hae.14874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pasquale Agosti
- Department of Pathophysiology and Transplantation and Fondazione Luigi Villa, Università degli Studi di Milano, Milan, Italy
| | - Maddalena Lettino
- Department for Cardiac, Thoracic and Vascular Diseases, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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6
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Kim JM, Stern RM, Maron BA. Bleeding and Myocardial Infarction in Acquired Factor VIII Deficiency. Circulation 2023; 148:1127-1133. [PMID: 37782697 DOI: 10.1161/circulationaha.123.063904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Affiliation(s)
- Joseph M Kim
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.M.K.)
- Harvard Medical School, Boston, MA (J.M.K., R.M.S., B.A.M.)
| | - Robert M Stern
- Harvard Medical School, Boston, MA (J.M.K., R.M.S., B.A.M.)
- Divisions of Hematology (R.M.S.), Brigham and Women's Hospital, Boston, MA
| | - Bradley A Maron
- Harvard Medical School, Boston, MA (J.M.K., R.M.S., B.A.M.)
- Cardiovascular Medicine (B.A.M.), Brigham and Women's Hospital, Boston, MA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD and the University of Maryland-Institute for Health Computing, Bethesda, MD (B.A.M.)
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7
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Camelo RM, Caram-Deelder C, Duarte BP, de Moura MCB, Costa NCDM, Costa IM, Vanderlei AM, Guimarães TMR, Gouw S, Rezende SM, van der Bom J. Cardiovascular Risk Scores among Asymptomatic Adults with Haemophilia. Arq Bras Cardiol 2023; 120:e20230004. [PMID: 37729292 PMCID: PMC10519352 DOI: 10.36660/abc.20230004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/12/2023] [Accepted: 07/17/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND The mortality rate of Brazilian people with haemophilia (PwH) is decreasing, but the relative incidence of deaths associated with cardiovascular disease (CVD) is increasing. OBJECTIVES We aimed to describe the CVD risk score of PwH according to Pooled Cohort Equations Risk (PCER) Calculator tool and its treatment recommendations. We also compared the PCER estimates with the respective Framingham Risk Score (FRS). METHODS This cross-sectional study included male PwH ≥ 40 years treated at the Comprehensive Haemophilia Treatment Centre of Pernambuco (Recife/Brazil). PwH with a previous CVD event or a low-density lipid cholesterol ≥ 5.0 mmol/L were excluded. Interviews, medical file reviews, and blood tests were performed. The PCER tool was used to estimate the CVD risk and compare it with the respective FRS. A p-value < 0.05 was accepted as statistically significant. RESULTS Thirty PwH were included. Median age was 51.5 [interquartile range-IQR; 46.0-59.5] years. The prevalence of obesity, systemic arterial hypertension, diabetes mellitus, hypertriglyceridaemia, hypercholesterolaemia, and hypoHDLaemia were 20%, 67%, 24%, 14%, 47%, and 23%, respectively. The median PCER score was 6.9% [IQR; 3.1-13.2], with 50% having a high risk (PCER ≥ 7.5%). Statin use was suggested for 54% of PwH. Blood pressure was poorly controlled in 47% of PwH. The agreement between PCER and FRS was 80% (κ = 0.60; p = 0.001). CONCLUSIONS Half of the male people with haemophilia aged 40 years or older had a 10-year high risk of developing CVD with strong recommendations to improve control of dyslipidaemia and blood pressure.
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Affiliation(s)
- Ricardo Mesquita Camelo
- Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilFaculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
- HEMOPERecifePEBrasilFundação de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, PE – Brasil
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenPaíses BaixosDepartment of Clinical Epidemiology, Leiden University Medical Center, Leiden – Países Baixos
| | - Camila Caram-Deelder
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenPaíses BaixosDepartment of Clinical Epidemiology, Leiden University Medical Center, Leiden – Países Baixos
- SanquinLUMCLeidenPaíses BaixosJon J van Rood Center for Clinical Transfusion Research, Sanquin/LUMC, Leiden – Países Baixos
| | - Bruna Pontes Duarte
- HEMOPERecifePEBrasilFundação de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, PE – Brasil
| | | | | | - Iris Maciel Costa
- HEMOPERecifePEBrasilFundação de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, PE – Brasil
| | - Ana Maria Vanderlei
- HEMOPERecifePEBrasilFundação de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, PE – Brasil
| | - Tania Maria Rocha Guimarães
- HEMOPERecifePEBrasilFundação de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, PE – Brasil
- Faculdade de Enfermagem Nossa Senhora das GraçasUniversidade de PernambucoRecifePEBrasilFaculdade de Enfermagem Nossa Senhora das Graças, Universidade de Pernambuco, Recife, PE – Brasil
| | - Samantha Gouw
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenPaíses BaixosDepartment of Clinical Epidemiology, Leiden University Medical Center, Leiden – Países Baixos
- Department of Pediatric HematologyEmma Children’s HospitalUniversity of AmsterdamAmsterdãPaíses BaixosDepartment of Pediatric Hematology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam,Amsterdã – Países Baixos
| | - Suely Meireles Rezende
- Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilFaculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Johanna van der Bom
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenPaíses BaixosDepartment of Clinical Epidemiology, Leiden University Medical Center, Leiden – Países Baixos
- SanquinLUMCLeidenPaíses BaixosJon J van Rood Center for Clinical Transfusion Research, Sanquin/LUMC, Leiden – Países Baixos
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Franchini M, Focosi D, Mannucci PM. How we manage cardiovascular disease in patients with hemophilia. Haematologica 2023; 108:1748-1757. [PMID: 36700406 PMCID: PMC10316236 DOI: 10.3324/haematol.2022.282407] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
With the striking advances in hemophilia care that have materialized particularly in the last two decades, an increasing number of persons with hemophilia (PWH) have achieved a quality of life and life expectancy very close to that of unaffected individuals. With aging, a growing number of PWH develop age-related co-morbidities, including cancer and cardiovascular disease. The latter (particularly coronary artery disease and atrial fibrillation) represent a new challenge for the hemophilia treatment centers because their management implies a delicate balance between the thrombotic risk and bleeding tendency, that is further enhanced by the concomitant use of antithrombotic agents. Because evidence from clinical trials is lacking, the management of PWH with cardiovascular diseases is mostly based on expert opinions, personal experiences, and the adaptation of the evidence stemming from studies on people without hemophilia. In this article, we focus on how to manage coronary artery disease and atrial fibrillation in patients with hemophilia.
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Affiliation(s)
- Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova.
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico and University of Milan, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
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9
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Schutgens RE, Jimenez-Yuste V, Escobar M, Falanga A, Gigante B, Klamroth R, Lassila R, Leebeek FW, Makris M, Owaidah T, Sholzberg M, Tiede A, Werring DJ, van der Worp HB, Windyga J, Castaman G. Antithrombotic Treatment in Patients With Hemophilia: an EHA-ISTH-EAHAD-ESO Clinical Practice Guidance. Hemasphere 2023; 7:e900. [PMID: 37304933 PMCID: PMC10256340 DOI: 10.1097/hs9.0000000000000900] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/24/2023] [Indexed: 06/13/2023] Open
Abstract
Cardiovascular disease is an emerging medical issue in patients with hemophilia (PWH) and its prevalence is increasing up to 15% in PWH in the United States. Atrial fibrillation, acute and chronic coronary syndromes, venous thromboembolism, and cerebral thrombosis are frequent thrombotic or prothrombotic situations, which require a careful approach to fine-tune the delicate balance between thrombosis and hemostasis in PWH when using both procoagulant and anticoagulant treatments. Generally, PWH could be considered as being naturally anticoagulated when clotting factors are <20 IU/dL, but specific recommendations in patients with very low levels according to the different clinical situations are lacking and mainly based on the anecdotal series. For PWH with baseline clotting factor levels >20 IU/dL in need for any form of antithrombotic therapy, usually treatment without additional clotting factor prophylaxis could be used, but careful monitoring for bleeding is recommended. For antiplatelet treatment, this threshold could be lower with single-antiplatelet agent, but again factor level should be at least 20 IU/dL for dual antiplatelet treatment. In this complex growing scenario, the European Hematology Association in collaboration with the International Society on Thrombosis and Haemostasis, the European Association for Hemophilia and Allied Disorders, the European Stroke Organization, and a representative of the European Society of Cardiology Working Group on Thrombosis has produced this current guidance document to provide clinical practice recommendations for health care providers who care for PWH.
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Affiliation(s)
- Roger E.G. Schutgens
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Victor Jimenez-Yuste
- Hematology Department, La Paz University Hospital, Autonoma University, Madrid, Spain
| | - Miguel Escobar
- University of Texas Health Science Center at Houston, TX, USA
| | - Anna Falanga
- University of Milano Bicocca, School of Medicine, Monza, Italy
- Department of Transfusion Medicine and Hematology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Bruna Gigante
- Division of Cardiovascular Medicine, Department of Medicine, Karolinska Institutet, Solna, Sweden
- Department of Clinical Science, Danderyd Hospital, Karolinska institutet, Stockholm, Sweden
| | - Robert Klamroth
- Department of Internal Medicine Angiology and Coagulation Disorders at the Vivantes Klinikum im Friedrichshain, Berlin, Germany
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Germany
| | - Riitta Lassila
- Department of Hematology, Coagulation Disorders Unit, and Research Program Unit in Systems Oncology Oncosys, Medical Faculty, University of Helsinki, Finland
| | - Frank W.G. Leebeek
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Michael Makris
- Haemophilia and Thrombosis Centre, University of Sheffield, United Kingdom
| | - Tarek Owaidah
- King Faisal Specialist Hospital and Research Centre, Alfaisal University, Riyadh, Saudi Arabia
| | - Michelle Sholzberg
- Division of Hematology-Oncology, Departments of Medicine, and Laboratory Medicine and Pathobiology, St. Michael’s Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Canada
| | - Andreas Tiede
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Germany
| | - David J. Werring
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, United Kingdom
| | | | - Jerzy Windyga
- Department of Hemostasis Disorders and Internal Medicine, Laboratory of Hemostasis and Metabolic Diseases, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
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10
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Chen H, Yang S. Acute coronary syndrome management in hemophiliacs: How to maintain balance?: A review. Medicine (Baltimore) 2023; 102:e33298. [PMID: 36930106 PMCID: PMC10019142 DOI: 10.1097/md.0000000000033298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
To analyze existing literature and understand how to balance the minimization of bleeding risk and ensuring adequate anticoagulation during coronary intervention treatment and long-term postoperative anticoagulation in hemophilia patients during the perioperative period, in order to provide guidance for healthcare professionals in developing effective treatment plans. This narrative review will analyze existing studies, case reports, and clinical guidelines to determine the most effective strategies for managing acute coronary syndrome in hemophilia patients. When evaluating the literature, factors such as patient age, medical history, and severity of the condition will be considered. The current management guidelines for acute coronary syndrome in hemophilia patients are not based on systematic evaluation and mainly rely on expert opinions. This article provides a comprehensive analysis of existing literature and recommends coagulation factor replacement therapy before anticoagulation and intervention treatment, as well as personalized anticoagulation treatment during the postoperative period for better management of hemophilia patients with acute coronary syndrome. These recommendations can help healthcare professionals develop more effective treatment plans for hemophilia patients.
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Affiliation(s)
- Hao Chen
- Internal Medicine Resident, Department of Cardiology, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Shaning Yang
- Department of Cardiology, The First Affiliated Hospital of Yangtze University, Jingzhou, China
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Klamroth R, Ay C, De Moerloose P, Fontana P, Windyga J, Astermark J, Berntorp E, Carvalho M, Dolan G, Hermans C, Holme PA, Kenet G, Mancuso ME, Marquardt N, Nunez R, Pabinger I, Rodgers R, Valk PVD, Yuste VJ, Zupan IP. Applicability of the European Society of Cardiology Guidelines on the management of acute coronary syndromes to older people with haemophilia A - A modified Delphi consensus by the ADVANCE Working Group. Haemophilia 2023; 29:21-32. [PMID: 36271497 DOI: 10.1111/hae.14674] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION As people with haemophilia (PWH) receive better treatment and live longer they are more likely to encounter cardiovascular disease (CVD) and other comorbidities. ESC guidelines for the acute management of patients presenting with acute coronary syndrome (ACS) are based on the non-haemophilia population. AIM To review the guidelines and propose relevant adaptations for PWHA without inhibitors who are treated with prophylaxis and present with ACS. METHODS As part of the ADVANCE Group, 20 European haemophilia experts used a modified Delphi approach to develop and gain consensus on proposed adaptations of the ESC guidelines for PWHA without inhibitors. RESULTS Of the 32 Class I recommendations across both guidelines, adaptions were considered necessary and proposed for 15. The adaptions highlight the need to provide sufficient FVIII trough levels at the time of antithrombotic treatment in people with haemophilia A (HA) without inhibitors. Patients receiving emicizumab prophylaxis and requiring oral anticoagulation therapy or combined single antiplatelet plus oral anticoagulation therapy will require additional FVIII replacement therapy. CONCLUSION In the absence of high-quality clinical evidence, the combined expert opinion used to develop these adaptions to the current ESC guidelines may help to guide clinicians in their treatment decisions when a PWHA presents with ACS.
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Affiliation(s)
| | - Cihan Ay
- Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | | | - Pierre Fontana
- Division of Angiology and Hemostasis, University Hospitals of Geneva, Geneva, Switzerland
| | - Jerzy Windyga
- Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | | | - Manuela Carvalho
- Congenital Coagulopathies Reference Center, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | | | | | | | - Gili Kenet
- Sheba Medical Center, Tel Hashomer & The Amalia Biron Thrombosis Research Institute, Tel Aviv University, Israel
| | | | - Natascha Marquardt
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Ingrid Pabinger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | | | - Paul van der Valk
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, University of Utrecht, The Netherlands
| | | | - Irena Preložnik Zupan
- University Medical Centre Ljubljana, Department of Haematology, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
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12
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Csöbönyeiová M, Beerová N, Klein M, Debreová-Čeháková M, Danišovič Ľ. Cell-Based and Selected Cell-Free Therapies for Myocardial Infarction: How Do They Compare to the Current Treatment Options? Int J Mol Sci 2022; 23:10314. [PMID: 36142245 PMCID: PMC9499607 DOI: 10.3390/ijms231810314] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022] Open
Abstract
Because of cardiomyocyte death or dysfunction frequently caused by myocardial infarction (MI), heart failure is a leading cause of morbidity and mortality in modern society. Paradoxically, only limited and non-curative therapies for heart failure or MI are currently available. As a result, over the past two decades research has focused on developing cell-based approaches promoting the regeneration of infarcted tissue. Cell-based therapies for myocardial regeneration include powerful candidates, such as multipotent stem cells (mesenchymal stem cells (MSCs), bone-marrow-derived stem cells, endothelial progenitor cells, and hematopoietic stem cells) and induced pluripotent stem cells (iPSCs). These possess unique properties, such as potency to differentiate into desired cell types, proliferation capacity, and patient specificity. Preclinical and clinical studies have demonstrated modest improvement in the myocardial regeneration and reduced infarcted areas upon transplantation of pluripotent or multipotent stem cells. Another cell population that need to be considered as a potential source for cardiac regeneration are telocytes found in different organs, including the heart. Their therapeutic effect has been studied in various heart pathologies, such as MI, arrhythmias, or atrial amyloidosis. The most recent cell-free therapeutic tool relies on the cardioprotective effect of complex cargo carried by small membrane-bound vesicles-exosomes-released from stem cells via exocytosis. The MSC/iPSC-derived exosomes could be considered a novel exosome-based therapy for cardiovascular diseases thanks to their unique content. There are also other cell-free approaches, e.g., gene therapy, or acellular cardiac patches. Therefore, our review provides the most recent insights into the novel strategies for myocardial repair based on the regenerative potential of different cell types and cell-free approaches.
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Affiliation(s)
- Mária Csöbönyeiová
- National Institute of Rheumatic Diseases, Nábrežie I. Krasku 4, 921 12 Piešťany, Slovakia
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University, Sasinkova 4, 811 08 Bratislava, Slovakia
| | - Nikoleta Beerová
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Sasinkova 4, 811 08 Bratislava, Slovakia
| | - Martin Klein
- National Institute of Rheumatic Diseases, Nábrežie I. Krasku 4, 921 12 Piešťany, Slovakia
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University, Sasinkova 4, 811 08 Bratislava, Slovakia
| | - Michaela Debreová-Čeháková
- National Institute of Rheumatic Diseases, Nábrežie I. Krasku 4, 921 12 Piešťany, Slovakia
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Sasinkova 4, 811 08 Bratislava, Slovakia
| | - Ľuboš Danišovič
- National Institute of Rheumatic Diseases, Nábrežie I. Krasku 4, 921 12 Piešťany, Slovakia
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Sasinkova 4, 811 08 Bratislava, Slovakia
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13
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Martens KL, Dekker SE, Crowe M, DeLoughery TG, Shatzel JJ. Challenging clinical scenarios for therapeutic anticoagulation: A practical approach. Thromb Res 2022; 218:72-82. [PMID: 36027629 PMCID: PMC9481720 DOI: 10.1016/j.thromres.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/20/2022] [Accepted: 08/15/2022] [Indexed: 01/03/2023]
Abstract
Therapeutic anticoagulation remains a fundamental backbone in the treatment and prevention of venous thromboembolism. However, while modern therapies are increasingly safe, anticoagulation is not without risks, particularly in those at high risk for or with recent bleeding. When weighing concurrent risks and benefits in each challenging clinical scenario, an individualized assessment of the risk and acuity of bleeding should be balanced by the indication for anticoagulation. Addressing modifiable risk factors and routine re-evaluation of any changes in this balance is critical. This review outlines available data and current guidelines for the management of anticoagulation in high-risk populations, including those with thrombocytopenia, elderly and high-fall risk, inherited bleeding disorders, and in acute coronary syndrome. We also examine management after clinically significant bleeding episodes, including intracranial hemorrhage, gastrointestinal bleeding, hemoptysis, retroperitoneal bleeding, hematuria, and abnormal uterine bleeding. The aim is to provide a comprehensive review of available literature to guide clinicians in providing optimal, safe, and individualized care for patients in these challenging scenarios.
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Affiliation(s)
- Kylee L. Martens
- Division of Hematology-Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States of America,Corresponding author at: OHSU Knight Cancer Institute, 3181 SW Sam Jackson Park Road, Mail Code: OC14HO, Portland, OR 97239, United States of America. (K.L. Martens)
| | - Simone E. Dekker
- Division of Internal Medicine, Oregon Health & Science University, Portland, OR, United States of America
| | - Megan Crowe
- Division of Internal Medicine, Oregon Health & Science University, Portland, OR, United States of America
| | - Thomas G. DeLoughery
- Division of Hematology-Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States of America
| | - Joseph J. Shatzel
- Division of Hematology-Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States of America
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14
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Shapiro S, Benson G, Evans G, Harrison C, Mangles S, Makris M. Cardiovascular disease in hereditary haemophilia: The challenges of longevity. Br J Haematol 2022; 197:397-406. [PMID: 35191019 PMCID: PMC9306870 DOI: 10.1111/bjh.18085] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022]
Abstract
The development of effective and safe treatments has significantly increased the life expectancy of persons with haemophilia (PWH). This has been accompanied by an increase in the comorbidities of ageing including cardiovascular disease, which poses particular challenges due to the opposing risks of bleeding from haemophilia and antithrombotic treatments versus thrombosis. Although mortality secondary to coronary artery disease in PWH is less than in the general population, the rate of atherosclerosis appears similar. The prevalence of atrial fibrillation in PWH and risk of secondary thromboembolic stroke are not well established. PWH can be safely supported through acute coronary interventions but data on the safety and efficacy of long-term antithrombotics are scarce. Increased awareness and research on cardiovascular disease in PWH will be crucial to improve primary prevention, acute management, secondary prevention and to best support ageing PWH.
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Affiliation(s)
- Susan Shapiro
- Oxford University Hospitals NHS Foundation TrustOxford NIHR Biomedical Research CentreOxfordUK
- Radcliffe Department of MedicineOxford UniversityOxfordUK
| | | | - Gillian Evans
- Kent Haemophilia and Thrombosis CentreEast Kent Hospitals University Foundation NHS TrustCanterburyUK
| | - Catherine Harrison
- Sheffield Haemophilia and Thrombosis CentreRoyal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Sarah Mangles
- Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation TrustBasingstokeUK
| | - Mike Makris
- Sheffield Haemophilia and Thrombosis CentreRoyal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
- Department of Infection, Immunity and Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
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15
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Aguiar-Ricardo I, Agostinho J, Pereira A, Rodrigues F, Brito D, Pinto FJ, Catarino C, Mendes Pedro M. Acute coronay syndrome in a patient with severe hemophilia A: Dificult decisions. Rev Port Cardiol 2021; 40:985.e1-985.e5. [PMID: 34922708 DOI: 10.1016/j.repce.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/10/2018] [Indexed: 11/28/2022] Open
Abstract
Hemophilia A is an inherited coagulation disease characterized by factor VIII (FVIII) deficiency and is associated with high hemorrhagic risk, especially in its severe forms. As the average life expectancy of patients with hemophilia has increased, so has the prevalence of acute coronary events. There is however limited experience in dealing with them. The strategy of acting on acute coronary events in patients with hemophilia, as demonstrated in the present case, is a real challenge, not only due to the need for antiplatelet therapy (which is essential in the prevention of stent thrombosis, but increases hemorrhagic risk), but also due to the lack of specific recommendations related to the most adequate and safe replacement therapy in these situations. The authors describe the case of a 48-year-old man with unstable angina and a previous diagnosis of severe hemophilia A who underwent percutaneous coronary intervention under FVIII therapy without hemorrhagic complications.
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Affiliation(s)
- Inês Aguiar-Ricardo
- Cardiology Department, Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Portugal.
| | - João Agostinho
- Cardiology Department, Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Portugal
| | - Artur Pereira
- Immunohemotherapy Department, Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Portugal
| | - Fátima Rodrigues
- Immunohemotherapy Department, Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Portugal
| | - Dulce Brito
- Cardiology Department, Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Portugal
| | - Cristina Catarino
- Immunohemotherapy Department, Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Portugal
| | - Mónica Mendes Pedro
- Cardiology Department, Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Portugal
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16
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Abou-Ismail MY, Connell NT. How to manage bleeding disorders in aging patients needing surgery. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:529-535. [PMID: 34889441 PMCID: PMC8791143 DOI: 10.1182/hematology.2021000288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
With improvements in medical care, the life expectancy of patients with bleeding disorders is approaching that of the general population. A growing population of older adult patients with bleeding disorders is at risk of age-related comorbidities and in need of various elective and emergent age-related procedures. The increased risk of thrombosis and volume overload in older adults complicates perioperative hemostatic management. Furthermore, antithrombotic treatment such as antiplatelet or anticoagulant therapy, which is frequently required for various cardiovascular interventions, requires a meticulous individualized approach. Evidence-based guidelines for the management of aging patients with bleeding disorders are lacking, largely due to the underrepresentation of older adult patients in clinical trials as well as the rarity of many such bleeding disorders. We discuss the current guidelines and recommendations in the perioperative hemostatic management of older adult patients with hemophilia and von Willebrand disease as well as other rare bleeding disorders. The optimal management of these patients is often complex and requires a thorough multidisciplinary and individualized approach involving hematologists, surgeons, anesthesiologists, and the specialists treating the underlying disorder.
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Affiliation(s)
- Mouhamed Yazan Abou-Ismail
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Nathan T Connell
- Hematology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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17
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Aguiar Ricardo I, Agostinho J, Pereira A, Rodrigues F, Brito D, Pinto FJ, Catarino C, Mendes Pedro M. Síndrome coronária aguda em doente com hemofilia A grave: decisões difíceis. Rev Port Cardiol 2021. [DOI: 10.1016/j.repc.2018.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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El Khoury M, Karam B, Tabet R, Lafferty JC, Snyder ST. Current Practice of Percutaneous Coronary Intervention in Patients With Coagulation Disorders. Cureus 2021; 13:e18284. [PMID: 34722061 PMCID: PMC8545607 DOI: 10.7759/cureus.18284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 11/05/2022] Open
Abstract
Acute coronary artery disease represents the leading cause of death worldwide. Some studies have shown that coagulation disorders can play a protective role against ischemic heart disease, presumably due to hypocoagulable state and decrease thrombin formation. However, autopsy reports showed atherosclerotic lesions in some patients with hemophilia. Since the introduction of clotting factors and replacement therapies, the life expectancy of patients with coagulation disorders has increased significantly. As a result, the incidence of cardiovascular diseases became higher making their treatment more challenging. Door to balloon strategy applies in ST-elevation myocardial infarction (STEMI), and percutaneous coronary intervention should not be delayed. While in non-STEMI (NSTEMI) and unstable angina, a hematology consult is essential. Prophylactic coagulation factor replacement is crucial in these patients in order to avoid bleeding complications, but on the other hand, these factors were also associated with thrombotic complications. Historically, bare-metal stents were preferred over drug-eluting stents in view of the shorter duration of dual antiplatelets therapy (DAPT). Currently, some trials have demonstrated the safety of new-generation drug-eluting stents in patients with elevated bleeding risk, where DAPT use is limited to four weeks. The radial artery is the preferred access and was found to have less bleeding complications when compared to the femoral access. Anticoagulation with heparin is the safest in view of antidote availability and shorter half-life. Bivalirudin has also been used in some case reports, while GP2b3a inhibitors are usually avoided except in a high thrombus burden. Close peri procedural follow-up is important with patient education about symptoms of bleed. Carefully and individually tailored antithrombotic and factor replacement therapy is required to overcome these clinically challenging situations. Early screening for cardiovascular risk factors and considering early intervention and management might help to improve the general health status of this population and reduce morbidity.
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Affiliation(s)
- Michel El Khoury
- Internal Medicine, Staten Island University Hospital - Northwell Health, New York City, USA
| | - Boutros Karam
- Cardiovascular Medicine, Staten Island University Hospital - Northwell Health, Staten Island, USA
| | - Rabih Tabet
- Cardiovascular Medicine, Staten Island University Hospital - Northwell Health, Staten Island, USA
| | - James C Lafferty
- Cardiovascular Medicine, Staten Island University Hospital - Northwell Health, Staten Island, USA
| | - Stavros Thomas Snyder
- Cardiovascular Medicine, Staten Island University Hospital - Northwell Health, Staten Island, USA
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19
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Badescu MC, Ciocoiu M, Rezus E, Badulescu OV, Tanase DM, Ouatu A, Dima N, Ganceanu-Rusu AR, Popescu D, Seritean Isac PN, Genes TM, Rezus C. Current Therapeutic Approach to Acute Myocardial Infarction in Patients with Congenital Hemophilia. Life (Basel) 2021; 11:1072. [PMID: 34685443 PMCID: PMC8537181 DOI: 10.3390/life11101072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 12/22/2022] Open
Abstract
Advances in the treatment of hemophilia have made the life expectancy of hemophiliacs similar to that of the general population. Physicians have begun to face age-related diseases not previously encountered in individuals with hemophilia. Treatment of acute myocardial infarction (AMI) is particularly challenging because the therapeutic strategies influence both the patient's thrombotic and hemorrhagic risk. As progress has been made in the treatment of AMI over the last decade, we performed an in-depth analysis of the available literature, highlighting the latest advances in the therapy of AMI in hemophiliacs. It is generally accepted that after the optimal substitution therapy has been provided, patients with hemophilia should be treated in the same way as those in the general population. New-generation stents that allow short dual antiplatelet therapy and potent P2Y12 receptor inhibitors have begun to be successfully used. At a time when specific recommendations and relevant data are scarce, our study provides up-to-date information to physicians involved in the treatment of AMI in hemophiliacs.
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Affiliation(s)
- Minerva Codruta Badescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Manuela Ciocoiu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
| | - Elena Rezus
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- I Rheumatology Clinic, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
| | - Oana Viola Badulescu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
- Hematology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Daniela Maria Tanase
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Anca Ouatu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Nicoleta Dima
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Ana Roxana Ganceanu-Rusu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Diana Popescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
| | - Petronela Nicoleta Seritean Isac
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
| | - Tudor-Marcel Genes
- Department of Neurology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
- Neurological Rehabilitation Clinic, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
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20
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Theodoropoulos KC, Vakalopoulou S, Oikonomou M, Stavropoulos G, Ziakas A, Kanonidis I, Kassimis G. How to Manage a Patient with Haemophilia and ACS Requiring PCI: A Battle between Bleeding and Thrombosis. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:352. [PMID: 33916890 PMCID: PMC8067578 DOI: 10.3390/medicina57040352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/19/2022]
Abstract
We present the case of a 70-year-old man with a history of haemophilia B, who presented to our hospital with a non-ST-elevation myocardial infarction. The patient, following consultation by a haemophilia expert, was revascularized with percutaneous coronary intervention (PCI) under adequate clotting factor administration. Patients with haemophilia and acute coronary syndrome, are susceptible to periprocedural bleeding and thrombotic events during PCI, and therefore a balanced management plan should always be implemented by a multidisciplinary team.
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Affiliation(s)
- Konstantinos C. Theodoropoulos
- Second Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (K.C.T.); (M.O.); (G.S.); (I.K.)
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - Sofia Vakalopoulou
- Haemophilia Centre of Northern Greece, Second Propaedeutic Department of Internal Medicine, Medical School, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - Maria Oikonomou
- Second Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (K.C.T.); (M.O.); (G.S.); (I.K.)
| | - George Stavropoulos
- Second Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (K.C.T.); (M.O.); (G.S.); (I.K.)
| | - Antonios Ziakas
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - Ioannis Kanonidis
- Second Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (K.C.T.); (M.O.); (G.S.); (I.K.)
| | - George Kassimis
- Second Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (K.C.T.); (M.O.); (G.S.); (I.K.)
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21
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Nagao A, Koganei H, Yamaguchi T, Fukutake K. Successful emicizumab prophylaxis during dual antiplatelet therapy for insertion of drug-eluting stents after acute coronary syndrome: A case report. Haemophilia 2021; 27:e549-e550. [PMID: 33780095 DOI: 10.1111/hae.14305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/07/2021] [Accepted: 03/15/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Azusa Nagao
- Department of Blood Coagulation, Ogikubo Hospital, Tokyo, Japan
| | | | - Tomoko Yamaguchi
- Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan
| | - Katsuyuki Fukutake
- Department of Blood Coagulation, Ogikubo Hospital, Tokyo, Japan.,Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan
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22
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Cohen OC, Bertelli M, Manmathan G, Little C, Riddell A, Pollard D, Aradom E, Mussara M, Harrington C, Kanagasabapathy P, De Silva R, Martin B, Peralta R, Gomez K, Yee T, Chowdary P, Rakhit RD. Challenges of antithrombotic therapy in the management of cardiovascular disease in patients with inherited bleeding disorders: A single-centre experience. Haemophilia 2021; 27:425-433. [PMID: 33749973 DOI: 10.1111/hae.14296] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Cardiovascular events in patients with inherited bleeding disorders are challenging to manage. The risk of bleeding secondary to antithrombotic treatment must be balanced against the risk of thrombosis secondary to haemostatic therapy. METHODS Patients with inherited bleeding disorders with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) or atrial fibrillation (AF) from a single centre (2010-2018) are included. RESULTS A total of 11 patients undergoing CABG (n = 3), PCI (n = 5) or with AF (n = 3) and a diagnosis of haemophilia A (n = 8), haemophilia B (n = 1), factor XI deficiency (n = 1) and von Willebrand disease (n = 1) managed by a multidisciplinary team are reported. In patients undergoing CABG, factor levels were normalized for 7-10 days with trough levels of 70-80% with severe patients continuing high-dose factor prophylaxis (trough 20-30%) three weeks post-operatively with daily aspirin. In a patient with mild haemophilia A and an inhibitor, recombinant factor VIIa dosing was monitored with thromboelastometry. For PCI, a 3rd-generation drug-eluting stent with one month of dual antiplatelet therapy in addition to high-dose prophylaxis as needed was preferred. Patients with AF and severe haemophilia did not receive antithrombotic treatment, and a thrombin generation assay was used to guide heparin dosing in mild haemophilia. CONCLUSION Our experience demonstrates the importance of interdisciplinary communication to identify strategies that decrease the risk of bleeding and thrombosis. The use of extended, increased intensity prophylaxis facilitated antiplatelet therapy. Global assays may help balance the intensity of haemostatic and antithrombotic treatment.
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Affiliation(s)
- Oliver C Cohen
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Michele Bertelli
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | | | - Callum Little
- Department of Cardiology, Royal Free Hospital, London, UK
| | - Anne Riddell
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Debra Pollard
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Elsa Aradom
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Molly Mussara
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Chris Harrington
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | | | - Ravi De Silva
- Department of Cardio-Thoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Bruce Martin
- Heart Hospital, University College London NHS Trust, London, UK
| | - Rita Peralta
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Keith Gomez
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Thynn Yee
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Roby D Rakhit
- Department of Cardiology, Royal Free Hospital, London, UK
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23
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Guillet B, Cayla G, Lebreton A, Trillot N, Wibaut B, Falaise C, Castet S, Gautier P, Claeyssens S, Schved JF. Long-Term Antithrombotic Treatments Prescribed for Cardiovascular Diseases in Patients with Hemophilia: Results from the French Registry. Thromb Haemost 2021; 121:287-296. [PMID: 33099283 PMCID: PMC7895544 DOI: 10.1055/s-0040-1718410] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/28/2020] [Indexed: 02/08/2023]
Abstract
Cardiovascular diseases (CVDs) are a major issue in aging patients with hemophilia (PWHs). Antithrombotic agents are widely used in the general population for CVD treatment, but this recommendation is not fully applicable to PWHs. To improve treatment strategies, a prospective case-control study (COCHE) that analyzed CVD management and follow-up (2 years/patient) in PWHs was performed in France from 2011 to 2018. In total, 68 PWHs (median age: 65 years [39-89]; 48 mild, 10 moderate, and 10 severe hemophilia) were included (n = 50 with acute coronary syndrome, n = 17 with atrial fibrillation, n = 1 with both). They were matched with 68 control PWHs without antithrombotic treatment. In our series, bleeding was significantly influenced by (1) hemophilia severity, with a mean annualized bleeding ratio significantly higher in COCHE patients than in controls with basal clotting factor level up to 20%, (2) antihemorrhagic regimen (on-demand vs. prophylaxis) in severe (hazard ratio [HR] = 16.69 [95% confidence interval, CI: 8.2-47.26]; p < 0.0001) and moderate hemophilia (HR = 42.43 [95% CI: 1.86-966.1]; p = 0.0028), (3) type of antithrombotic treatment in mild hemophilia, with a significantly higher risk of bleeding in COCHE patients than in controls for dual-pathway therapy (HR = 15.64 [95% CI: 1.57-115.8]; p = 0.019), anticoagulant drugs alone (HR = 9.91 [95% CI: 1.34-73.47]; p = 0.0248), dual antiplatelet therapy (HR = 5.31 [95% CI: 1.23-22.92]; p = 0.0252), and single antiplatelet therapy (HR = 3.76 [95% CI: 1.13-12.55]; p = 0.0313); and (4) HAS-BLED score ≥3 (odds ratio [OR] = 33 [95% CI: 1.43-761.2]; p = 0.0065). Gastrointestinal bleeding was also significantly higher in COCHE patients than in controls (OR = 15 [95% CI: 1.84-268]; p = 0.0141). The COCHE study confirmed that antithrombotic treatments in PWHs are associated with increased bleeding rates in function of hemophilia-specific factors and also of known factors in the general population.
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Affiliation(s)
- Benoît Guillet
- Centre Régional de Traitement des Maladies Hémorragiques, CHU de Rennes, et Université de Rennes 1, France
- CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Univ Rennes, UMR_S 1085, Rennes, France
| | - Guillaume Cayla
- Service de Cardiologie CHU de Nîmes, Université de Montpellier, Nimes, France
| | - Aurélien Lebreton
- Centre Régional de Traitement des Hémophiles, CHU de Clermont-Ferrand, France
| | - Nathalie Trillot
- Centre Régional de Traitement des Hémophiles, CHU de Lille, France
| | - Bénédicte Wibaut
- Centre Régional de Traitement des Hémophiles, CHU de Lille, France
| | - Céline Falaise
- Centre Régional de Traitement des Hémophiles, CHU La Timone, Marseille, France
| | - Sabine Castet
- Centre Régional de Traitement des Hémophiles, CHU de Bordeaux, France
| | - Philippe Gautier
- Centre Régional de Traitement des Hémophiles, CHU de Caen, France
| | | | - Jean-François Schved
- Centre Régional de Traitement des Hémophiles, Hôpital Saint-Eloi, CHRU de Montpellier, Montpellier, France
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24
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Chen YW, Chen WJ, Tseng MS, Lo HC, Shih MY, Chen YJ, Lee WL, Wang JD. Consecutive complex percutaneous coronary interventions using emicizumab and recombinant activated factor VII in a patient with severe haemophilia A and high-titre inhibitor. Haemophilia 2020; 27:e385-e388. [PMID: 32997880 DOI: 10.1111/hae.14165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/13/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Yu-Wei Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Jhong Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Min-Sheng Tseng
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Cardiology, Department of Internal Medicine, Kuang-Tien General Hospital, Taichung, Taiwan
| | - Hsu-Chung Lo
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Yang Shih
- Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan.,Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Jen Chen
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jiaan-Der Wang
- Center for Rare Disease and Hemophilia, Taichung Veterans General Hospital, Taichung, Taiwan.,Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
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25
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Kempton CL, Makris M, Holme PA. Management of comorbidities in haemophilia. Haemophilia 2020; 27 Suppl 3:37-45. [PMID: 32476243 DOI: 10.1111/hae.14013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/07/2020] [Indexed: 02/06/2023]
Abstract
With the introduction of clotting factor concentrates in the early 1970s, significant improvements in quality of life and life expectancy of persons with haemophilia (PWH) were realized. Unfortunately, as a result of transmission of HIV and hepatitis C virus (HCV) by contaminated concentrates in the 1980s, many of these gains were lost. Now with four decades of PWH unexposed to contaminated factor products and current treatments capable of suppressing and eliminating HIV and HCV, respectively, the survival rate is once again increasing. In addition to the usual comorbidities associated with advanced age in the general population, several specific issues occur in patients with bleeding disorders. This manuscript explores the incidence and management of the comorbidities of the ageing PWH with a focus on cardiovascular disease and osteoporosis.
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Affiliation(s)
- Christine L Kempton
- Department of Hematology and Medical Oncology and Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael Makris
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, UK
| | - Pål Andre Holme
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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26
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Piel-Julian ML, Thiercelin-Legrand MF, Moulis G, Voisin S, Claeyssens S, Sailler L. Antithrombotic therapy management in patients with inherited bleeding disorders and coronary artery disease: A single-centre experience. Haemophilia 2019; 26:e34-e37. [PMID: 31846115 DOI: 10.1111/hae.13904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/17/2019] [Accepted: 11/25/2019] [Indexed: 01/25/2023]
Affiliation(s)
- Marie-Léa Piel-Julian
- Service de Médecine Interne, salle Le Tallec, Centre Hospitalier Universitaire de Toulouse-Purpan, Toulouse, France
| | - Marie-Françoise Thiercelin-Legrand
- Service de Médecine Interne, salle Le Tallec, Centre Hospitalier Universitaire de Toulouse-Purpan, Toulouse, France.,Centre régional d'hémophilie, Centre Hospitalier Universitaire de Toulouse-Purpan, Toulouse, France
| | - Guillaume Moulis
- Service de Médecine Interne, salle Le Tallec, Centre Hospitalier Universitaire de Toulouse-Purpan, Toulouse, France.,Centre d'investigation clinique 1436, axe pharmacoépidémiologie, Centre Hospitalier Universitaire de Toulouse-Purpan, Toulouse, France
| | - Sophie Voisin
- Laboratoire d'hématologie, Centre Hospitalier Universitaire de Toulouse-Purpan, Toulouse, France
| | - Ségolène Claeyssens
- Centre régional d'hémophilie, Centre Hospitalier Universitaire de Toulouse-Purpan, Toulouse, France
| | - Laurent Sailler
- Service de Médecine Interne, salle Le Tallec, Centre Hospitalier Universitaire de Toulouse-Purpan, Toulouse, France.,Centre d'investigation clinique 1436, axe pharmacoépidémiologie, Centre Hospitalier Universitaire de Toulouse-Purpan, Toulouse, France
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27
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Tiede A, Giangrande P, Teitel J, Amano K, Benson G, Nemes L, Jiménez-Yuste V, d'Oiron R, Benchikh El Fegoun S, Kessler CM. Clinical evaluation of bleeds and response to haemostatic treatment in patients with acquired haemophilia: A global expert consensus statement. Haemophilia 2019; 25:969-978. [PMID: 31517435 DOI: 10.1111/hae.13844] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/30/2019] [Accepted: 08/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Acquired haemophilia (AH) is a rare bleeding disorder with significant morbidity and mortality. Most patients initially present to physicians without experience of the disease, delaying diagnosis and potentially worsening outcomes. Existing guidance in AH is limited to clinical opinion of few experts and does not address monitoring bleeds in specific anatomical locations. AIM Derive consensus from a large sample of experts around the world in monitoring bleeding patients with AH. METHODS Using the Delphi methodology, a structured survey, designed to derive consensus on how to monitor bleeding patients with AH, was developed by a steering committee for completion by a group of haematologists with an interest in AH. Consensus was defined as ≥75% agreement with a given survey statement. After three rounds of survey refinement, a final list of consensus statements was compiled. RESULTS Thirty-six global specialists in AH participated. The participants spanned 20 countries and had treated a median of 12.0 (range, 1-50) patients with AH within the preceding 5 years. Consensus was achieved in all items after three survey rounds. In addition to statements on general management of bleeding patients, consensus statements in the following areas were presented: urinary tract, gastrointestinal tract, muscles, skin, joints, nose, pharynx, mouth, intracranial and postpartum. CONCLUSIONS Here, we present consensus statements derived from a broad sample of global specialists to address monitoring of location-specific bleeds and evaluating efficacy of bleeding treatment in patients with AH. These statements could be applied in practice by treating physicians and validated by individual population surveys.
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Affiliation(s)
| | | | - Jerome Teitel
- St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Roseline d'Oiron
- Centre de Référence de l'Hémophilie et des Maladies Hémorragiques Constitutionnelles rares, Hôpitaux Universitaires Paris Sud-APHP-Hôpital Bicêtre, Le Kremlin-Bicêtre, France
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28
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Aging with Hemophilia: The Challenge of Appropriate Drug Prescription. Mediterr J Hematol Infect Dis 2019; 11:e2019056. [PMID: 31528322 PMCID: PMC6736229 DOI: 10.4084/mjhid.2019.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/13/2019] [Indexed: 12/31/2022] Open
Abstract
In high-income countries persons with severe hemophilia (PWH) A and B are aging, like their age-matched peers without hemophilia from the general population. Aging is associated not only with the comorbidities stemming from their inherited bleeding disorder (arthropathy, chronic viral infections such as hepatitis and AIDS) but also with the multiple chronic ailments associated with aging (cancer, cardiovascular disease, COPD). Multimorbidity is inevitably associated with polypharmacy, i.e., the chronic daily intake of at least five drugs, and with the related risk of severe adverse events associated with the use of inappropriate drugs and drug-drug interactions. Information on the pattern of drug prescription and usage by PWH is relatively scanty, but on the whole, the available data indicate that the rate of polypharmacy, as well as the risk of drug-drug interaction, is relatively low in PWH and better than that in their age peers without hemophilia followed by general practitioners. It is believed that this advantage results from the collaborative coordination on drug prescribing exerted, through their integration with practitioners and organ specialists, by specialized hemophilia treatment centers in the frame of comprehensive care programs. However, the available cross-sectional data were mainly obtained in relatively young PWH, so that there is a need to obtain more accurate data from the ongoing prospective studies that are being carried out in more and more progressively aging PWH.
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29
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A cross-sectional analysis of cardiovascular disease in the hemophilia population. Blood Adv 2019; 2:1325-1333. [PMID: 29895623 DOI: 10.1182/bloodadvances.2018018226] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/01/2018] [Indexed: 01/13/2023] Open
Abstract
Men with hemophilia were initially thought to be protected from cardiovascular disease (CVD), but it is now clear that atherothrombotic events occur. The primary objective of the CVD in Hemophilia study was to determine the prevalence of CVD and CVD risk factors in US older men with moderate and severe hemophilia and to compare findings with those reported in age-comparable men in the Atherosclerosis Risk in Communities (ARIC) cohort. We hypothesized if lower factor levels are protective from CVD, we would see a difference in CVD rates between more severely affected and unaffected men. Beginning in October 2012, 200 patients with moderate or severe hemophilia A or B (factor VIII or IX level ≤ 5%), aged 54 to 73 years, were enrolled at 19 US hemophilia treatment centers. Data were collected from patient interview and medical records. A fasting blood sample and electrocardiogram (ECG) were obtained and assayed and read centrally. CVD was defined as any angina, any myocardial infarction by ECG or physician diagnosis, any self-reported nonhemorrhagic stroke or transient ischemic attack verified by physicians, or any history of coronary bypass graft surgery or coronary artery angioplasty. CVD risk factors were common in the population. Compared with men of similar age in the ARIC cohort, patients with hemophilia had significantly less CVD (15% vs 25.8%; P < .001). However, on an individual patient level, CVD events occur and efforts to prevent cardiovascular events are warranted. Few men were receiving secondary prophylaxis with low-dose aspirin, despite published opinion that it can be used safely in this patient population.
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30
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Loloi J, Gilchrist IC. Hemophilia in the cath lab: Balancing the need to clot with the treatment of thrombosis. Catheter Cardiovasc Interv 2018; 92:16-17. [DOI: 10.1002/ccd.27701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 05/30/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Justin Loloi
- College of Medicine, Heart & Vascular Institute, MS Hershey Medical Center; Pennsylvania State University; Hershey Pennsylvania
| | - Ian C. Gilchrist
- College of Medicine, Heart & Vascular Institute, MS Hershey Medical Center; Pennsylvania State University; Hershey Pennsylvania
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31
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Jabbar AY, Baydoun H, Janbain M, Ferdinand KC. Current concepts in the management of stable ischemic heart disease and acute coronary syndrome in patients with hemophilia. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:299. [PMID: 30211187 DOI: 10.21037/atm.2018.05.29] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Coronary artery disease (CAD), including stable ischemic heart disease (SIHD) and acute coronary syndrome (ACS), remains the leading cause of death in the US and one of the primary modalities used in the treatment of CAD is percutaneous coronary intervention (PCI). Despite the potential benefits of PCI in high risk CAD patients, the risk of hemorrhage presents a dilemma in the treatment of patients with hemophilia A and B. In an attempt to provide guidance on the management of SIHD and ACS in patients with hemophilia, we present the case of a patient with moderate hemophilia B and ACS who subsequently underwent PCI followed by a review of the associated literature.
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Affiliation(s)
- Ahmad Y Jabbar
- Department of Medicine, Tulane School of Medicine, Tulane Heart and Vascular Institute, New Orleans, LA, USA
| | - Hassan Baydoun
- Department of Medicine, Tulane School of Medicine, Tulane Heart and Vascular Institute, New Orleans, LA, USA
| | - Maissaa Janbain
- Department of Medicine, Tulane School of Medicine, Tulane Heart and Vascular Institute, New Orleans, LA, USA
| | - Keith C Ferdinand
- Department of Medicine, Tulane School of Medicine, Tulane Heart and Vascular Institute, New Orleans, LA, USA
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32
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Revascularization strategies and in-hospital management in acute coronary syndromes complicated by hemophilia A or hemophilia B. Blood Coagul Fibrinolysis 2017; 28:650-657. [DOI: 10.1097/mbc.0000000000000655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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33
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Feng B, Xiao K, Shao J, Fan Y, Weng X. Open repair of intraoperative popliteal artery injury during total knee arthroplasty in a patient with severe hemophilia A: A case report and literature review. Medicine (Baltimore) 2017; 96:e8791. [PMID: 29145340 PMCID: PMC5704885 DOI: 10.1097/md.0000000000008791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Arterial injuries during total knee arthroplasty (TKA) though rare may occur. Hemophilia may further challenge the management of such injury. PATIENT CONCERNS A 48-year-old male patient with severe hemophilia type A and stiff knee arthropathy underwent bilateral TKAs. Left popliteal artery injury was detected at the end of the left TKA. DIAGNOSES Urgent angiography confirmed the diagnosis of the left popliteal artery transection. INTERVENTIONS With clotting factor VIII replacement treatment, open repair was performed by end-to-end vascular bypass with the autograft of the large saphenous vein. No anticoagulant and antiplatelet treatment was administered postoperatively. Doses of the factor VIII were decreased step by step postoperatively. OUTCOMES Left lower limb was reperfused 4 hours after the onset of the ischemia. The patient recovered uneventfully. Postoperative Doppler examination showed the left popliteal artery remained patent. LESSONS The hemophilia may endanger the patients to higher risk of arterial injury during TKA because of the severe deformity and fibrosis around knee joint. For the hemophilia patients, with rational coagulation factor replacement therapy, open repair with autograft was an effective revascularization procedure for artery injury.
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Affiliation(s)
- Bin Feng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital
| | - Ke Xiao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Yu Fan
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital
| | - Xisheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital
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34
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Dolan G. Partnering to change the world for people with haemophilia: 7th Haemophilia Global Summit, Madrid, Spain 22-24 September 2016. Eur J Haematol 2017; 99 Suppl 87:3-9. [PMID: 28921738 DOI: 10.1111/ejh.12924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2017] [Indexed: 01/19/2023]
Abstract
The 7th Haemophilia Global Summit was held in Madrid, Spain, in September 2016. With a programme designed, for the 6th consecutive year, by a Scientific Steering Committee of haemophilia experts, the aim of the summit was to share optimal management strategies for haemophilia at all life stages and to provide an opportunity for specialists from across the haemophilia multidisciplinary care team to engage in discussion and debate with leading international experts on current and future areas of research. Topics covered ranged from the optimisation of haemophilia management, emerging issues in clinical care, practical approaches and future perspectives, in addition to patient engagement and empowerment in modern haemophilia care.
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35
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Boehnel C, Rickli H, Graf L, Maeder MT. Coronary angiography with or without percutaneous coronary intervention in patients with hemophilia-Systematic review. Catheter Cardiovasc Interv 2017; 92:1-15. [DOI: 10.1002/ccd.27255] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 07/24/2017] [Accepted: 07/29/2017] [Indexed: 12/14/2022]
Affiliation(s)
| | - Hans Rickli
- Cardiology Department; Kantonsspital St. Gallen; Switzerland
| | - Lukas Graf
- Center for Laboratory Medicine; Hemostasis and Hemophilia Center; St. Gallen Switzerland
| | - Micha T. Maeder
- Cardiology Department; Kantonsspital St. Gallen; Switzerland
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36
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Larsen JB, Nielsen KBJ, Poulsen LH, Bor MV. Arterial and Venous Thrombosis in Haemophilia Patients: Experiences from a Danish Haemophilia Centre. Acta Haematol 2017; 138:91-95. [PMID: 28817815 DOI: 10.1159/000477928] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/29/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Julie Brogaard Larsen
- Centre for Haemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
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37
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Miesbach W, Reitter-Pfoertner SE, Klamroth R, Langer F, Wolf HH, Tiede A, Siegmund B, Scholz U, Müller PR, Eichler H, Pabinger I. Co-morbidities and bleeding in elderly patients with haemophilia-A survey of the German, Austrian and Swiss Society of Thrombosis and Haemostasis Research (GTH). Haemophilia 2017. [DOI: 10.1111/hae.13296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- W. Miesbach
- Medical Clinic II; Institute of Transfusion Medicine; Goethe University; Frankfurt Germany
| | - S.-E. Reitter-Pfoertner
- Division of Haematology and Haemostaseology; Department of Medicine I; Medical University; Vienna Austria
| | - R. Klamroth
- Department of Angiology and Haemostaseology; Vivantes Clinic; Berlin Germany
| | - F. Langer
- II. Medical Clinic; University Clinic Eppendorf; Hamburg Germany
| | | | - A. Tiede
- Hannover Medical School; Hannover Germany
| | - B. Siegmund
- Institute for Thrombophilia and Haemaostaseology; Münster Germany
| | - U. Scholz
- Center of Haemostasis; MVZ Labor Leipzig; Germany
| | | | - H. Eichler
- Institute of Haemostaseology and Transfusion Medicine; University Hospital; Homburg/Saar Germany
| | - I. Pabinger
- Division of Haematology and Haemostaseology; Department of Medicine I; Medical University; Vienna Austria
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Berntorp E, Dargaud Y, Hart D, Lobet S, Mancuso ME, d'Oiron R, Perry D, Pollard D, van den Berg M, Blatný J, Chambost H, Doria AS, Holme PA, Kaczmarek R, Mantovani L, McLaughlin P, Nanayakkara L, Petrini P, Sannié T, Laane E, Maia R, Dettoraki A, Farrell A, Halimeh S, Raza S, Taylor S. The second Team Haemophilia Education Meeting, 2016, Frankfurt, Germany. Eur J Haematol 2017; 98 Suppl 85:1-15. [DOI: 10.1111/ejh.12828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Erik Berntorp
- Skåne University Hospital; Lund University; Malmö Sweden
| | - Yesim Dargaud
- Clinical Haemostasis Unit; Lyon Hospital; University of Lyon; Lyon France
| | - Daniel Hart
- Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - Sébastien Lobet
- Service d'hématologie; Cliniques Universitaires Saint-Luc; Brussels Belgium
| | - Maria Elisa Mancuso
- Fondazione IRCCS Ca’ Granda; Ospedale Maggiore Policlinico; Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; Milan Italy
| | - Roseline d'Oiron
- Centre for Haemophilia and Rare Congenital Bleeding Disorders; University Hospitals Paris-Sud; AP-HP Bicêtre Hospital; Le Kremlin-Bicêtre France
| | - David Perry
- Addenbrooke's Hospital; University of Cambridge; Cambridge UK
| | - Debra Pollard
- Katharine Dormandy Haemophilia & Thrombosis Centre; Royal Free Hospital; London UK
| | - Marijke van den Berg
- Department of Health and Epidemiology; University of Utrecht; Utrecht The Netherlands
| | - Jan Blatný
- Department of Paediatric Haematology; Children's University Hospital and Masaryk University; Brno Czech Republic
| | - Hervé Chambost
- Department of Paediatrics; La Timone Children Hospital; APHM and Aix-Marseille University; Marseille France
| | - Andrea S. Doria
- Department of Diagnostic Imaging; The Hospital for Sick Children; Toronto ON Canada
- Department of Medical Imaging; University of Toronto; Toronto ON Canada
| | - Pål André Holme
- Department of Haematology and Institute of Clinical Medicine; Oslo University and Oslo University Hospital; Rikshospitalet Norway
| | - Radoslaw Kaczmarek
- Hirszfeld Institute of Immunology and Experimental Therapy; Wroclaw Poland
| | - Lorenzo Mantovani
- Public Health; CESP-Center of Public Health Research; University of Milano-Bicocca; Milan Italy
| | - Paul McLaughlin
- Department of Physiotherapy; Katharine Dormandy Haemophilia Centre; Royal Free Hospital; London UK
| | | | - Pia Petrini
- Department of Paediatrics; Karolinska University Hospital; Stockholm Sweden
| | - Thomas Sannié
- Association Française des Hémophilies (AFH); Paris France
| | | | - Raquel Maia
- Paediatric Haematology Unit; Dona Estefânia Hospital; Lisbon Portugal
| | - Athina Dettoraki
- Haemophilia Centre and Haemostasis Unit; ‘Aghia Sophia’ Children's Hospital; Athens Greece
| | | | - Susan Halimeh
- Gerinnungszentrum Rhein-Ruhr (GZRR); Duisburg Germany
| | - Sayma Raza
- Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - Stephanie Taylor
- Oxford Haemophilia and Thrombosis Centre; Oxford University Hospitals Foundation Trust; Oxford UK
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Acute Coronary Syndromes in Patients with Hematological Disorders. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2016. [DOI: 10.1515/jce-2016-0024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Abstract
Hematological conditions can lead to serious disturbances in blood rheology, being frequently associated with increased systemic inflammation and increased risk of bleeding. The imbalance between coagulation and thrombolytic factors in patients with acute coronary syndromes may lead to undesirable outcomes, and the success of emergency coronary angioplasty or by-pass grafting may be altered by increased bleeding in coagulopathies such as hemophilia. This paper intends to review the present knowledge in the field of acute coronary syndromes in subjects with hematological and onco-hematological disorders such as thrombotic thrombocytopenic purpura, immune thrombocytopenic purpura, von Willebrand disease, hemophilia, polycythemia vera, erythrocyte disorders, myelodysplastic syndrome, leukemia, lymphoma or myeloma.
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Schutgens REG, Voskuil M, Mauser-Bunschoten EP. Management of cardiovascular disease in aging persons with haemophilia. Hamostaseologie 2016; 37:196-201. [PMID: 27966004 DOI: 10.5482/hamo-16-09-0037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/24/2016] [Indexed: 12/12/2022] Open
Abstract
With the aging of the haemophilia population, age related comorbidities become more and more a medical issue. Managing haemophilia patients with cardiovascular disease is a difficult task for many haemophilia-treating physicians. Over the years, insights on prevalence, risk factors and management of cardiovascular disease in haemophilia have improved substantially. It is now recognised that many risk factors, such as hypertension and overweight, occur quite frequently in patients with haemophilia. Several new insights in anticoagulation management of atrial fibrillation and coronary ischaemia in haemophilia have been suggested. This review provides an general overview of the current knowledge of these topics in literature.
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Affiliation(s)
- Roger E G Schutgens
- Roger E. G. Schutgens, MD, PhD, MSc, Van Creveldkliniek, UMC Utrecht, Heidelberglaan 100 3584CX Utrecht, The Netherlands, Tel: +31 88 7558450,
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41
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Berger K, Schopohl D, Lowe G, Holme PA, Tait RC, Combescure C, Rauchensteiner S, Klamroth R. How to compare cardiovascular disease and risk factors in elderly patients with haemophilia with the general population. Haemophilia 2016; 22:e406-16. [DOI: 10.1111/hae.13069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2016] [Indexed: 12/13/2022]
Affiliation(s)
- K. Berger
- Department of Haematology/Oncology; University Hospital of Munich; Munich Germany
| | - D. Schopohl
- Department of Haematology/Oncology; University Hospital of Munich; Munich Germany
| | - G. Lowe
- Haemophilia Centre; Glasgow UK
- Royal Infirmary; Glasgow UK
| | - P. A. Holme
- Department of Haematology; Oslo University Hospital and Institute of Clinical Medicine University of Oslo; Oslo Norway
| | - R. C. Tait
- Haemophilia Centre; Glasgow UK
- Royal Infirmary; Glasgow UK
| | - C. Combescure
- University Hospital and Faculty of Medicine of Geneva; Geneva Switzerland
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Casini A, de Moerloose P. Management of congenital quantitative fibrinogen disorders: a Delphi consensus. Haemophilia 2016; 22:898-905. [PMID: 27640400 DOI: 10.1111/hae.13061] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION No evidence-based guidelines for the management of patients suffering from afibrinogenaemia and hypofibrinogenaemia are available. AIM AND METHOD The aim of this study was to harmonize patient's care among invited haemophilia experts from Belgium, France and Switzerland. A Delphi-like methodology was used to reach a consensus on: prophylaxis, bleeding, surgery, pregnancy and thrombosis management. RESULTS The main final statements are as follows: (i) a secondary fibrinogen prophylaxis should be started after a first life-threatening bleeding in patients with afibrinogenaemia; (ii) during prophylaxis the target trough fibrinogen level should be 0.5 g L-1 ; (iii) if an adaptation of dosage is required, the frequency of infusions rather than the fibrinogen amount should be modified; (iv) afibrinogenaemic patients undergoing a surgery at high bleeding risk should receive fibrinogen concentrates regardless of the personal or family history of bleeding; (v) moderate hypofibrinogenaemic patients (i.e. ≥0.5 g L-1 ) without previous bleeding (despite haemostatic challenges) undergoing a surgery at low bleeding risk may not receive fibrinogen concentrates as prophylaxis; (vi) monitoring the trough fibrinogen levels should be performed at least once a month throughout the pregnancy and a foetal growth and placenta development close monitoring by ultrasound is recommended; (vii) fibrinogen replacement should be started concomitantly to the introduction of anticoagulation in afibrinogenaemic patients suffering from a venous thromboembolic event; and (viii) low-molecular-weight heparin is the anticoagulant of choice in case of venous thromboembolism. CONCLUSION The results of this initiative should help clinicians in the difficult management of patients with congenital fibrinogen disorders.
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Affiliation(s)
- A Casini
- Division of Angiology and Haemostasis, University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - P de Moerloose
- Division of Angiology and Haemostasis, University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Chang CY, Lin SY, Tsai JR, Tsai CH, Chen YC. Successful multivessel percutaneous coronary intervention for acute coronary syndrome in a HIV-positive severe haemophiliac. Haemophilia 2016; 22:e481-4. [PMID: 27501528 DOI: 10.1111/hae.13056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2016] [Indexed: 12/14/2022]
Affiliation(s)
- C-Y Chang
- School of Medicine, Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan.,Hemophilia Center, Division of Pediatric Hematology/Oncology, Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan
| | - S-Y Lin
- School of Medicine, Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - J-R Tsai
- School of Medicine, Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Hematology/Oncology, Taipei Medical University Hospital, Taipei, Taiwan
| | - C-H Tsai
- School of Medicine, Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Hematology/Oncology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Y-C Chen
- Division of Hematology/Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. .,Hemophilia Care and Research Center, Tri-Service General Hospital, Taipei, Taiwan.
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Berntorp E, Mauser-Bunschoten E, Jiménez-Yuste V, Spears JB. Comorbidities and inhibitors in adult patients with haemophilia: issues, costs and management strategies. Eur J Haematol 2016; 95 Suppl 80:1-15. [PMID: 26492487 DOI: 10.1111/ejh.12681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 01/19/2023]
Abstract
Along with greater life expectancy in patients with haemophilia has been an increase in associated haemophilia-related (arthropathy, osteoporosis, viral infections) and age-related (cardiovascular disease, renal disease, cancer and others) comorbidities, many of which are only just emerging as the population ages. At present, experience in managing these comorbidities is limited. As the demographic shift continues, haemophilia care centres can expect to encounter more patients with greater levels of complexity. In the absence of evidence-based information to guide the management of adult patients with haemophilia, it is important that the scientific position be reviewed on a regular basis. To this end, several topics relevant to the clinical management of adult patients with haemophilia were examined in a symposium entitled Comorbidities and inhibitors in adult patients with haemophilia: issues, costs and management strategies held on 11 February 2015 in Helsinki, Finland, in conjunction with the 8th Annual Congress of the European Association for Haemophilia and Allied Disorders. This article is a summary of that event.
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Affiliation(s)
- Erik Berntorp
- Clinical Coagulation Research Unit, Skåne University Hospital, Malmö, Sweden
| | - Evelien Mauser-Bunschoten
- Van Creveldkliniek, Department of Benign Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Víctor Jiménez-Yuste
- La Paz University Hospital, Coagulopathy Unit, Haematology Service, Madrid, Spain
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Martin K, Key NS. How I treat patients with inherited bleeding disorders who need anticoagulant therapy. Blood 2016; 128:178-84. [PMID: 27106121 PMCID: PMC4946199 DOI: 10.1182/blood-2015-12-635094] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/12/2016] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- Karlyn Martin
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Nigel S Key
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC
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Sousos N, Gavriilaki E, Vakalopoulou S, Garipidou V. Understanding cardiovascular risk in hemophilia: A step towards prevention and management. Thromb Res 2016; 140:14-21. [DOI: 10.1016/j.thromres.2016.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/31/2016] [Accepted: 02/01/2016] [Indexed: 01/03/2023]
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Abstract
With advances in care, increasing numbers of people with hemophilia (PWH) achieve near-normal life expectancies and present with typical age-related cardiovascular conditions. Evidence-based guidelines for medical or surgical management of cardiovascular conditions in individuals with hemophilia are limited. Published recommendations exist for the management of some common cardiovascular conditions (eg, ischemic heart disease, atrial fibrillation), but identifying optimal strategies for anticoagulant or antithrombotic therapy constitutes the primary challenge of managing nonoperative cardiovascular disease (CVD) in PWH. In general, as long as factor concentrates or other hemostatic therapies maintain adequate hemostasis, the recommended medical and surgical management of CVD in PWH parallels that in individuals without hemophilia. The presence of factor inhibitors complicates hemophilia management. Published outcomes of CVD treatment in PWH are similar to those in the general population. Specific knowledge about factor replacement, factor inhibitors, and disease-specific treatment distinguishes the cardiovascular care of PWH from similar care of individuals without this rare bleeding disorder. Furthermore, a multidisciplinary approach incorporating a hematologist with an onsite coagulation laboratory, ideally associated with a hemophilia treatment center, is integral to the management of CVD in PWH.
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48
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Minuk L, Jackson S, Iorio A, Poon MC, Dilworth E, Brose K, Card R, Rizwan I, Chin-Yee B, Louzada M. Cardiovascular disease (CVD) in Canadians with haemophilia: Age-Related CVD in Haemophilia Epidemiological Research (ARCHER study). Haemophilia 2015. [DOI: 10.1111/hae.12768] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- L. Minuk
- Division of Hematology; Department of Medicine; Western University; London ON Canada
| | - S. Jackson
- Division of Hematology; Department of Medicine; University of British Columbia; Vancouver BC Canada
| | - A. Iorio
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
| | - M.-C. Poon
- Department of Medicine and The Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program; University of Calgary and Alberta Health Services; Calgary AB Canada
| | - E. Dilworth
- Division of Hematology; Department of Medicine; Western University; London ON Canada
| | - K. Brose
- Division of Hematology; University of Saskatchewan; Saskatoon AB Canada
| | - R. Card
- Division of Hematology; University of Saskatchewan; Saskatoon AB Canada
| | - I. Rizwan
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
| | - B. Chin-Yee
- Division of Hematology; Department of Medicine; Western University; London ON Canada
| | - M. Louzada
- Division of Hematology; Department of Medicine; Western University; London ON Canada
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Neufeld EJ, Négrier C, Arkhammar P, el Fegoun SB, Simonsen MD, Rosholm A, Seremetis S. Safety update on the use of recombinant activated factor VII in approved indications. Blood Rev 2015; 29 Suppl 1:S34-41. [PMID: 26073367 DOI: 10.1016/s0268-960x(15)30006-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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50
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de Raucourt E, Roussel-Robert V, Zetterberg E. Prevention and treatment of atherosclerosis in haemophilia - how to balance risk of bleeding with risk of ischaemic events. Eur J Haematol 2015; 94 Suppl 77:23-9. [DOI: 10.1111/ejh.12498] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Emmanuelle de Raucourt
- HUPVNS, Hôpital Beaujon, Service d'Hematologie Biologique; Clichy and Centre d'Hémophilie Hopital Mignot; Le Chesnay France
| | | | - Eva Zetterberg
- Department of Hematology and Coagulation; Skåne University Hospital; Malmö Sweden
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