With improved replacement therapy, people with haemophilia (PWH) live longer, with the consequent emergence of age-related chronic diseases not previously seen in haemophilia. The prevalence of cardiovascular disease and associated complications in older PWH appears to be on the rise. Management of myocardial infarction in a person living with severe haemophilia presents a particular challenge, as treatment options often include antiplatelet therapy, anti-coagulation and invasive procedures. Current guidelines for managing acute myocardial infarction are not specifically designed for people with bleeding diatheses such as haemophilia. We present a patient with severe haemophilia A on extended half-life factor VIII prophylaxis who developed an acute ST-elevation myocardial infarction (STEMI), discuss his clinical management and highlight lessons learned.
1. Angelini D, Konkle BA, Sood SL. Aging among persons with hemophilia: contemporary concerns. Semin Hematol 2016; 53(1): 35-9.
2. Biere-Rafi S, Baarslag MA, Peters M, Kruip MJ, et al. Cardiovascular risk assessment in haemophilia patients. Thromb Haemost 2011; 105(2): 274-8.
3. Kamphuisen PW, ten Cate H. Cardiovascular risk in patients with hemophilia. Blood 2014; 123(9): 1297-301.
4. 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.
5. Dolan G. The challenge of an ageing haemophilic population. Haemophilia 2010; 16 Suppl 5: 11-16.
6. Cerrato E, Calcagno A, D'Ascenzo F, et al. Cardiovascular disease in HIV patients: from bench to bedside and backwards. Open Heart 2015; 2(1): e000174.
7. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2017; 39(2): 119-77. doi: 10.1093/eurheartj/ehx393.
8. Helft G. Dual antiplatelet therapy duration after drug-eluting stents: how long? J Thorac Dis 2016; 8(8): E844-6.
9. Schutgens RE, Tuinenburg A, Roosendaal G, Guyomi SH, Mauser-Bunschoten EP. Treatment of ischaemic heart disease in haemophilia patients: an institutional guideline. Haemophilia 2009; 15(4): 952-8.
10. Philipp C. The aging patient with hemophilia: complications, comorbidities, and management issues. Hematology Am Soc Hematol Educ Program 2010; 2010: 191-6.
11. Pocoski J, Ma A, Kessler CM, Boklage S, Humphries TJ. Cardiovascular comorbidities are increased in U.S. patients with haemophilia A: a retrospective database analysis. Haemophilia 2014; 20(4): 472-8.