TY - JOUR
T1 - Antithrombotic Treatment in Patients With Hemophilia
T2 - an EHA-ISTH-EAHAD-ESO Clinical Practice Guidance
AU - Schutgens, Roger E.G.
AU - Jimenez-Yuste, Victor
AU - Escobar, Miguel
AU - Falanga, Anna
AU - Gigante, Bruna
AU - Klamroth, Robert
AU - Lassila, Riitta
AU - Leebeek, Frank W.G.
AU - Makris, Michael
AU - Owaidah, Tarek
AU - Sholzberg, Michelle
AU - Tiede, Andreas
AU - Werring, David J.
AU - Van Der Worp, H. Bart
AU - Windyga, Jerzy
AU - Castaman, Giancarlo
N1 - Publisher Copyright:
© 2023 Wolters Kluwer Health. All rights reserved.
PY - 2023/6/5
Y1 - 2023/6/5
N2 - Cardiovascular disease is an emerging medical issue in patients with hemophilia (PWH) and its prevalence is increasing up to 15% in PWH in the United States. Atrial fibrillation, acute and chronic coronary syndromes, venous thromboembolism, and cerebral thrombosis are frequent thrombotic or prothrombotic situations, which require a careful approach to fine-tune the delicate balance between thrombosis and hemostasis in PWH when using both procoagulant and anticoagulant treatments. Generally, PWH could be considered as being naturally anticoagulated when clotting factors are <20 IU/dL, but specific recommendations in patients with very low levels according to the different clinical situations are lacking and mainly based on the anecdotal series. For PWH with baseline clotting factor levels >20 IU/dL in need for any form of antithrombotic therapy, usually treatment without additional clotting factor prophylaxis could be used, but careful monitoring for bleeding is recommended. For antiplatelet treatment, this threshold could be lower with single-antiplatelet agent, but again factor level should be at least 20 IU/dL for dual antiplatelet treatment. In this complex growing scenario, the European Hematology Association in collaboration with the International Society on Thrombosis and Haemostasis, the European Association for Hemophilia and Allied Disorders, the European Stroke Organization, and a representative of the European Society of Cardiology Working Group on Thrombosis has produced this current guidance document to provide clinical practice recommendations for health care providers who care for PWH.
AB - Cardiovascular disease is an emerging medical issue in patients with hemophilia (PWH) and its prevalence is increasing up to 15% in PWH in the United States. Atrial fibrillation, acute and chronic coronary syndromes, venous thromboembolism, and cerebral thrombosis are frequent thrombotic or prothrombotic situations, which require a careful approach to fine-tune the delicate balance between thrombosis and hemostasis in PWH when using both procoagulant and anticoagulant treatments. Generally, PWH could be considered as being naturally anticoagulated when clotting factors are <20 IU/dL, but specific recommendations in patients with very low levels according to the different clinical situations are lacking and mainly based on the anecdotal series. For PWH with baseline clotting factor levels >20 IU/dL in need for any form of antithrombotic therapy, usually treatment without additional clotting factor prophylaxis could be used, but careful monitoring for bleeding is recommended. For antiplatelet treatment, this threshold could be lower with single-antiplatelet agent, but again factor level should be at least 20 IU/dL for dual antiplatelet treatment. In this complex growing scenario, the European Hematology Association in collaboration with the International Society on Thrombosis and Haemostasis, the European Association for Hemophilia and Allied Disorders, the European Stroke Organization, and a representative of the European Society of Cardiology Working Group on Thrombosis has produced this current guidance document to provide clinical practice recommendations for health care providers who care for PWH.
UR - http://www.scopus.com/inward/record.url?scp=85161942864&partnerID=8YFLogxK
U2 - 10.1097/HS9.0000000000000900
DO - 10.1097/HS9.0000000000000900
M3 - Article
AN - SCOPUS:85161942864
SN - 2572-9241
VL - 7
SP - 1
EP - 21
JO - Hemasphere
JF - Hemasphere
IS - 6
M1 - e900
ER -