The management of cardiovascular diseases in patients with hemophilia

Morbidity and mortality for cardiovascular disease are likely to be lower in patients with hemophilia than in the general male population. However, their clinical impact is increasing in parallel with the increase of life expectancy due to modern safe replacement treatments and the improvement of comprehensive care of these patients. No rigorous trial concerning treatment of ischemic coronary disease is currently available, and such studies are probably not feasible in this setting. Given the lack of evidence-based guidelines, the analysis of case reports describing management of coronary artery disease and cardiac surgery in hemophilic patients suggests that treatment strategies should be similar to those used in nonhemophilic subjects, provided that an adequate concentrate replacement is administered. On the whole, treatment should be tailored for balancing the actual thrombotic risk and the preexisting bleeding tendency, enhanced by the use of antithrombotic agents. In this review, the available information is discussed, together with the recent suggestions of experts developed to provide more uniform approaches and collection of data. Treatment of cardiovascular disease reflects the evolving scenario in which clinicians who treat hemophilia will have to extend their interactions with other specialists to confront the new challenges of the comprehensive care of aging hemophilic patients.