Antiplatelet therapy for patients with hemophilia after percutaneous coronary intervention

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Background: The incidence of coronary artery disease is increasing in hemophilia patients as their life expectancy improves. However, there are limited evidencebased studies available, and most current guidelines for antiplatelet therapy in patients with hemophilia are largely based on expert opinions. The assessment of benefit and risk of using antiplatelet therapy in these patients remains a clinical challenge. Aim: This study reports our institution's clinical outcome of patients with inherited hemophilia who underwent antiplatelet therapy for percutaneous coronary intervention in the last 10 years. Methods: Retrospective chart review from a single hospital for 10 calendar years of patients with inherited hemophilia A or B and a diagnosis of coronary artery disease who received oral antiplatelet agents. Results: See data Table 1 below. Conclusions: The usage of antiplatelet therapy for coronary artery disease as well as dual-antiplatelet therapy post percutaneous coronary intervention in patients with Hemophilia A or B carries a realistic risk of bleeding. However, outside of one patient with traumatic laceration of the liver, we did not identify any life threatening bleeding events in our patients who were placed on antiplatelet therapy. Since all subjects had no more than mild to moderate factor deficiency, it would be important to see how patients with severe deficiency would do on such therapy. Further studies are needed in the future to provide evidence and clarify the overall risk versus benefit of antiplatelet therapy in hemophilia patients with coronary artery disease.




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