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Semin Thromb Hemost 2010; 36(1): 091-102
DOI: 10.1055/s-0030-1248728
© Thieme Medical Publishers

The Management of Cardiovascular Diseases in Patients with Hemophilia

Antonio Coppola1 , Annarita Tagliaferri2 , Massimo Franchini3
  • 1Regional Reference Centre for Coagulation Disorders, Federico II University Hospital, Naples, Italy
  • 2Regional Reference Centre for Inherited Bleeding Disorders, University Hospital, Parma, Italy
  • 3Department of Pathology and Laboratory Medicine, Immunohaematology and Transfusion Centre, University Hospital, Parma, Italy
Further Information

Publication History

Publication Date:
13 April 2010 (online)

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ABSTRACT

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.

KEYWORDS

Antiplatelet agents - anticoagulation - bleeding risk - cardiovascular disease - acute coronary syndromes - comorbidities - hemophilia - percutaneous coronary intervention

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Massimo FranchiniM.D. 

Immunohematology and Transfusion Center

Department of Pathology and Laboratory Medicine, University Hospital of Parma, Parma, Italy

Email: mfranchini@ao.pr.it