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Management of cardiovascular disease in haemophilia.
Thromb Res 2013; 132(1):8-14TR

Abstract

Improvements in the management of haemophilia have led to a significant increase in the life expectancy of haemophilia patients, which is now close to the life expectancy in the general male population. Therefore, age-related conditions, especially cardiovascular disease (CVD), have become increasingly common in these patients. The management of CVD, especially that of coronary artery disease (CAD), acute coronary syndrome (ACS) and atrial fibrillation (AF), is particularly challenging in patients with haemophilia due to the need to find an adequate balance between bleeding and ischemic risk, requiring close coordination between cardiologists and haemophilia specialists. However, specific recommendations and relevant literature and data are scarce. Therefore, we propose pragmatic and practical therapeutic suggestions, based on the available literature and our own experience, for the management of ACS, stable angina and AF in patients with haemophilia. Overall, evidence and experience suggest that they should be treated much in the same way as the general CVD population, following standard guidelines, while choosing available treatment options known to be associated with low rates of bleeding complications. Treatments advocated for patient with haemophilia include antiplatelet therapy (aspirin and P2Y12 inhibitors), antithrombin therapy such as heparin or bivalirudin, glycoprotein IIb/IIIa inhibitors (GPIIb/IIIa inhibitors), transradial cardiac catheterization, and use of bare metal (BMS) or drug-eluting stents (DES). Antithrombotic agents with shorter half-lives that are reversible or have an antidote offer a safer choice in this setting. In addition, optimal clotting factor replacement therapy should be tailored to the increased risk of bleeding associated with invasive procedures and antithrombotic therapies, particularly during the acute phase of ACS.

Authors+Show Affiliations

GHU Carémeau, Service de Cardiologie, CHU de Nîmes, France.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

23746627

Citation

Cayla, Guillaume, et al. "Management of Cardiovascular Disease in Haemophilia." Thrombosis Research, vol. 132, no. 1, 2013, pp. 8-14.
Cayla G, Morange PE, Chambost H, et al. Management of cardiovascular disease in haemophilia. Thromb Res. 2013;132(1):8-14.
Cayla, G., Morange, P. E., Chambost, H., & Schved, J. F. (2013). Management of cardiovascular disease in haemophilia. Thrombosis Research, 132(1), pp. 8-14. doi:10.1016/j.thromres.2013.05.007.
Cayla G, et al. Management of Cardiovascular Disease in Haemophilia. Thromb Res. 2013;132(1):8-14. PubMed PMID: 23746627.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of cardiovascular disease in haemophilia. AU - Cayla,Guillaume, AU - Morange,Pierre-Emmanuel, AU - Chambost,Hervé, AU - Schved,Jean-François, Y1 - 2013/06/06/ PY - 2013/02/17/received PY - 2013/05/02/revised PY - 2013/05/05/accepted PY - 2013/6/11/entrez PY - 2013/6/12/pubmed PY - 2014/3/13/medline KW - ACS KW - AF KW - CAD KW - CVD KW - ECG KW - MI KW - NSTE-ACS KW - PCI KW - ST elevation myocardial infarction KW - STEMI KW - UA KW - acute coronary syndrome KW - antiplatelet therapy KW - atrial fibrillation KW - cardiovascular disease KW - coronary artery disease KW - electrocardiogram KW - haemophilia KW - myocardial infarction KW - non-ST elevation acute coronary syndrome KW - percutaneous coronary intervention KW - stent KW - unstable angina SP - 8 EP - 14 JF - Thrombosis research JO - Thromb. Res. VL - 132 IS - 1 N2 - Improvements in the management of haemophilia have led to a significant increase in the life expectancy of haemophilia patients, which is now close to the life expectancy in the general male population. Therefore, age-related conditions, especially cardiovascular disease (CVD), have become increasingly common in these patients. The management of CVD, especially that of coronary artery disease (CAD), acute coronary syndrome (ACS) and atrial fibrillation (AF), is particularly challenging in patients with haemophilia due to the need to find an adequate balance between bleeding and ischemic risk, requiring close coordination between cardiologists and haemophilia specialists. However, specific recommendations and relevant literature and data are scarce. Therefore, we propose pragmatic and practical therapeutic suggestions, based on the available literature and our own experience, for the management of ACS, stable angina and AF in patients with haemophilia. Overall, evidence and experience suggest that they should be treated much in the same way as the general CVD population, following standard guidelines, while choosing available treatment options known to be associated with low rates of bleeding complications. Treatments advocated for patient with haemophilia include antiplatelet therapy (aspirin and P2Y12 inhibitors), antithrombin therapy such as heparin or bivalirudin, glycoprotein IIb/IIIa inhibitors (GPIIb/IIIa inhibitors), transradial cardiac catheterization, and use of bare metal (BMS) or drug-eluting stents (DES). Antithrombotic agents with shorter half-lives that are reversible or have an antidote offer a safer choice in this setting. In addition, optimal clotting factor replacement therapy should be tailored to the increased risk of bleeding associated with invasive procedures and antithrombotic therapies, particularly during the acute phase of ACS. SN - 1879-2472 UR - https://www.unboundmedicine.com/medline/citation/23746627/Management_of_cardiovascular_disease_in_haemophilia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-3848(13)00199-0 DB - PRIME DP - Unbound Medicine ER -