We aimed to summarize the evidence for periprocedural and long-term
strategies to both minimize the bleeding risk and ensure sufficient
anticoagulation and antiaggregation in hemophilia patients
undergoing coronary angiography with or without percutaneous
coronary interventions (PCI).
Hemophilia patients undergoing coronary angiography and PCI are at
risk of bleeding due to deficiency of the essential clotting factors
VIII or IX combined with the need of peri-interventional
anticoagulation and antiaggregation and dual antiplatelet therapy
(DAPT) after PCI.
We report on a patient with moderate hemophilia B undergoing
single-vessel PCI with administration of factor IX concentrate
during the procedure and during the 1-month DAPT period. In
addition, a systematic review of patients (n = 54, mean age
58 ± 10 years) with hemophilia A (n = 45, 83%)
or B (n = 9, 17%) undergoing coronary angiography with or without
PCI is presented.
Peri-interventional factor substitution was performed in the
majority (42 of 54, 78%) but not all patients. In 38 of 54 (70%)
patients undergoing coronary angiography, PCI with balloon dilation
(n = 5), bare metal (n = 31), or drug-eluting stents (n = 2) was
performed. For PCI unfractioned heparin (n = 24), low molecular
weight heparin (n = 2), bivalirudin (n = 4), or no periprocedural
anticoagulation at all (n = 8) were used. PCI was successful in all
cases. After stenting, the majority (28 of 33; 85%) was treated with
DAPT (median duration 1 month). Major periprocedural bleeding
episodes occurred in 3 of 54 (6%) patients. Bleeding during
follow-up occurred in 11 of 54 (20%) patients.
Coronary angiography and PCI in patients with hemophilia are
effective and safe when applying individualized measures to prevent