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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(8):650-657BC

Abstract

: Among adult patients with hemophilia A and hemophilia B the emergent management of acute coronary syndromes (ACSs) is challenging, and exposure to antithrombotic agents and/or revascularization procedures may confer an enhanced risk of bleeding. We sought to identify clinical characteristics and in-hospital outcomes among ACS patients with hemophilia A/hemophilia B, compared with matched noncoagulopathic ACS controls. Case discharges from the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (1998-2011) had International Classification of Diseases, 9th Revision codes for hemophilia A/hemophilia B and ACS. Control discharges were matched to cases by year of discharge and hospital. Discharges in both groups were assessed for cardiovascular risk factors, type of ACS, use of coronary artery bypass grafting, percutaneous coronary intervention (PCI), bare-metal stent and/or drug-eluting stent, bleeding, and death. In total, 237 cases and 148 848 matched controls were identified. Among cases, HIV/Hepatitis C positivity was more common and obesity/hyperlipidemia less common. ST-elevation myocardial infarction (STEMI) occurred less frequently among hemophilia A cases than controls. hemophilia A and hemophilia B cases were more likely to be managed medically. Cases treated with coronary stent placement were more likely to receive a bare-metal stent than controls. Among PCI, bleeding was more common among hemophilia A cases. The death rates were comparable between groups. ACS-hemophilia A/hemophilia B cases were more often treated noninvasively compared with controls, suggesting an avoidance of PCI/coronary artery bypass grafting in this population, and bleeding (among hemophilia A) was more common. These findings support further study of the management of ACS and in-hospital outcomes among individuals with hemophilia.

Authors+Show Affiliations

aDepartment of Medicine, University of Pennsylvania Health SystembDepartment of Biostatistics, Epidemiology and informatics, University of PennsylvaniacCardiovascular Division, Penn Presbyterian Medical CenterdDivision of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA*Phyllis A. Gimotty and Patrick F. Fogarty contributed equally to this article.†Address where work was carried out. Present address: 500 Arcola Road, Collegeville, PA 19426, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28763308

Citation

Reilley, Matthew J., et al. "Revascularization Strategies and In-hospital Management in Acute Coronary Syndromes Complicated By Hemophilia a or Hemophilia B." Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis, vol. 28, no. 8, 2017, pp. 650-657.
Reilley MJ, Blair A, Matthai WH, et al. Revascularization strategies and in-hospital management in acute coronary syndromes complicated by hemophilia A or hemophilia B. Blood Coagul Fibrinolysis. 2017;28(8):650-657.
Reilley, M. J., Blair, A., Matthai, W. H., Vega, R., Buckley, M., Gimotty, P. A., & Fogarty, P. F. (2017). Revascularization strategies and in-hospital management in acute coronary syndromes complicated by hemophilia A or hemophilia B. Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis, 28(8), pp. 650-657. doi:10.1097/MBC.0000000000000655.
Reilley MJ, et al. Revascularization Strategies and In-hospital Management in Acute Coronary Syndromes Complicated By Hemophilia a or Hemophilia B. Blood Coagul Fibrinolysis. 2017;28(8):650-657. PubMed PMID: 28763308.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Revascularization strategies and in-hospital management in acute coronary syndromes complicated by hemophilia A or hemophilia B. AU - Reilley,Matthew J, AU - Blair,Anne, AU - Matthai,William H, AU - Vega,Rolando, AU - Buckley,Meghan, AU - Gimotty,Phyllis A, AU - Fogarty,Patrick F, PY - 2017/8/2/pubmed PY - 2018/8/2/medline PY - 2017/8/2/entrez SP - 650 EP - 657 JF - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JO - Blood Coagul. Fibrinolysis VL - 28 IS - 8 N2 - : Among adult patients with hemophilia A and hemophilia B the emergent management of acute coronary syndromes (ACSs) is challenging, and exposure to antithrombotic agents and/or revascularization procedures may confer an enhanced risk of bleeding. We sought to identify clinical characteristics and in-hospital outcomes among ACS patients with hemophilia A/hemophilia B, compared with matched noncoagulopathic ACS controls. Case discharges from the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (1998-2011) had International Classification of Diseases, 9th Revision codes for hemophilia A/hemophilia B and ACS. Control discharges were matched to cases by year of discharge and hospital. Discharges in both groups were assessed for cardiovascular risk factors, type of ACS, use of coronary artery bypass grafting, percutaneous coronary intervention (PCI), bare-metal stent and/or drug-eluting stent, bleeding, and death. In total, 237 cases and 148 848 matched controls were identified. Among cases, HIV/Hepatitis C positivity was more common and obesity/hyperlipidemia less common. ST-elevation myocardial infarction (STEMI) occurred less frequently among hemophilia A cases than controls. hemophilia A and hemophilia B cases were more likely to be managed medically. Cases treated with coronary stent placement were more likely to receive a bare-metal stent than controls. Among PCI, bleeding was more common among hemophilia A cases. The death rates were comparable between groups. ACS-hemophilia A/hemophilia B cases were more often treated noninvasively compared with controls, suggesting an avoidance of PCI/coronary artery bypass grafting in this population, and bleeding (among hemophilia A) was more common. These findings support further study of the management of ACS and in-hospital outcomes among individuals with hemophilia. SN - 1473-5733 UR - https://www.unboundmedicine.com/medline/citation/28763308/Revascularization_strategies_and_in_hospital_management_in_acute_coronary_syndromes_complicated_by_hemophilia_A_or_hemophilia_B_ L2 - http://Insights.ovid.com/pubmed?pmid=28763308 DB - PRIME DP - Unbound Medicine ER -