Coronary Revascularization in Patients with Hemophilia and Acute Coronary Syndrome: Case Report and Brief Literature
Giuseppe Vadalà1,2, Giulia Mingoia1, Giuseppe Astuti1
1Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University Hospital "Paolo Giaccone", University of Palermo, 90133 Palermo, Italy.
Insights
Managing acute coronary syndrome (ACS) in hemophilia patients requires balancing bleeding and clotting risks. A novel approach using drug-coated balloons and spot stenting offers a safer revascularization strategy for these high-risk individuals.
Area of Science:
- Cardiology
- Hematology
- Interventional Cardiology
Background:
- Management of acute coronary syndrome (ACS) in patients with hemophilia is challenging due to bleeding risks.
- Hemophilic patients often receive less invasive treatments for ACS, potentially impacting cardiovascular outcomes.
- Balancing thrombotic and bleeding risks necessitates a multidisciplinary approach involving hematologists.
Purpose of the Study:
- To present an alternative revascularization strategy for hemophilic patients with ACS and diffuse coronary artery disease (CAD).
- To evaluate the feasibility of using drug-coated balloons (DCBs) combined with spot stenting.
- To review current literature and guidelines for managing ACS in hemophilia.
Main Methods:
- Clinical case report of a hemophilic patient with ACS.
- Utilized drug-coated balloons (DCBs) and spot stenting as an alternative to full drug-eluting stent (DES) implantation.
- Literature review focusing on ACS management in hemophilia and high bleeding risk (HBR) patients.
Main Results:
- The proposed strategy potentially avoids extensive stent implantation.
- This approach may allow for a shorter dual antiplatelet therapy (DAPT) duration, crucial for high bleeding risk (HBR) patients.
- The case illustrates a viable option for myocardial revascularization in complex hemophilic patients.
Conclusions:
- A combination of DCBs and spot stenting presents a promising alternative revascularization strategy for hemophilic patients with ACS.
- This approach may mitigate bleeding risks associated with traditional treatments.
- Further research and guideline refinement are needed to optimize ACS care in hemophilia.
Abstract:
The current management of patients with acute coronary syndrome (ACS) and bleeding disorders, such as hemophilia, is supported by small retrospective studies or expert consensus documents. Moreover, people with hemophilia are less likely to receive invasive treatments like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for ACS compared to those without hemophilia, which could affect their cardiovascular outcomes. A multidisciplinary team with an expert hematologist is essential to properly define the therapeutic strategy, which should balance both the thrombotic and bleeding risks. We report a clinical case that illustrates an alternative revascularization strategy for hemophilic patients presenting with ACS and with a pattern of diffuse coronary atherosclerotic disease (CAD), encompassing drug-coated balloons (DCBs) in combination with spot stenting. The proposed approach might avoid a full-length drug-eluting stent (DES) implantation and also allow a short dual antiplatelet therapy (DAPT) regimen that is desirable in patients at a very high bleeding risk (HBR) like hemophiliacs. Furthermore, we have provided a review of the available literature on this topic and a focus on the main recommendations for managing ACS, in response to the presented clinical case. Finally, this article aims to share information and develop more confidence in the current guidelines on the treatment of hemophiliacs who need myocardial revascularization.
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