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Prevention and treatment of atherosclerosis in haemophilia - how to balance risk of bleeding with risk of ischaemic events

de Raucourt, Emmanuelle; Roussel-Robert, Valerie and Zetterberg, Eva LU (2015) In European Journal of Haematology 94. p.23-29
Abstract
Life expectancy for patients with haemophilia (PWH) has significantly increased in the last decades, due to improvement of clotting factor replacement therapy. However, despite a lower cardiovascular mortality rate and contrasting prevalence for non-fatal ischaemic heart disease (IHD), cardiovascular diseases are increasing in PWH. The prevalence of cardiovascular risk factors in PWH is as prevalent as in the general population, whereas an increased risk of hypertension has been observed in some studies. Furthermore, PWH are not protected against atherosclerosis. Coronary artery disease treatment is extremely challenging in PWH. Two institutional' guidelines for the management of IHD in PWH have been published. Since these recommendations,... (More)
Life expectancy for patients with haemophilia (PWH) has significantly increased in the last decades, due to improvement of clotting factor replacement therapy. However, despite a lower cardiovascular mortality rate and contrasting prevalence for non-fatal ischaemic heart disease (IHD), cardiovascular diseases are increasing in PWH. The prevalence of cardiovascular risk factors in PWH is as prevalent as in the general population, whereas an increased risk of hypertension has been observed in some studies. Furthermore, PWH are not protected against atherosclerosis. Coronary artery disease treatment is extremely challenging in PWH. Two institutional' guidelines for the management of IHD in PWH have been published. Since these recommendations, the use of new drugs such as prasugrel, ticagrelor, bivalirudin, new oral anticoagulants and new drug-eluting stents have been recommended in the general population but should be evaluated in PWH. Some questions arise: which trough level during long-term single or dual antiplatelet treatment (DAT) is really needed? The clinical role of platelet testing remains ill defined but may be considered in selected patients. A multidisciplinary approach is necessary for the management of IHD in PWH in order to treat the patient as any patient according to the cardiological guidelines during the acute phase, and long-term management should be discussed. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
atherosclerosis, haemophilia, bleeding, coronary artery disease, hypertension
in
European Journal of Haematology
volume
94
pages
23 - 29
publisher
Wiley-Blackwell
external identifiers
  • wos:000347371100006
  • scopus:84920270558
ISSN
1600-0609
DOI
10.1111/ejh.12498
language
English
LU publication?
yes
id
e7bfad41-abf3-43ca-ae06-62f62003a0ed (old id 5076000)
date added to LUP
2015-02-28 09:03:23
date last changed
2017-09-10 03:13:45
@article{e7bfad41-abf3-43ca-ae06-62f62003a0ed,
  abstract     = {Life expectancy for patients with haemophilia (PWH) has significantly increased in the last decades, due to improvement of clotting factor replacement therapy. However, despite a lower cardiovascular mortality rate and contrasting prevalence for non-fatal ischaemic heart disease (IHD), cardiovascular diseases are increasing in PWH. The prevalence of cardiovascular risk factors in PWH is as prevalent as in the general population, whereas an increased risk of hypertension has been observed in some studies. Furthermore, PWH are not protected against atherosclerosis. Coronary artery disease treatment is extremely challenging in PWH. Two institutional' guidelines for the management of IHD in PWH have been published. Since these recommendations, the use of new drugs such as prasugrel, ticagrelor, bivalirudin, new oral anticoagulants and new drug-eluting stents have been recommended in the general population but should be evaluated in PWH. Some questions arise: which trough level during long-term single or dual antiplatelet treatment (DAT) is really needed? The clinical role of platelet testing remains ill defined but may be considered in selected patients. A multidisciplinary approach is necessary for the management of IHD in PWH in order to treat the patient as any patient according to the cardiological guidelines during the acute phase, and long-term management should be discussed.},
  author       = {de Raucourt, Emmanuelle and Roussel-Robert, Valerie and Zetterberg, Eva},
  issn         = {1600-0609},
  keyword      = {atherosclerosis,haemophilia,bleeding,coronary artery disease,hypertension},
  language     = {eng},
  pages        = {23--29},
  publisher    = {Wiley-Blackwell},
  series       = {European Journal of Haematology},
  title        = {Prevention and treatment of atherosclerosis in haemophilia - how to balance risk of bleeding with risk of ischaemic events},
  url          = {http://dx.doi.org/10.1111/ejh.12498},
  volume       = {94},
  year         = {2015},
}