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Applicability of the European Society of Cardiology guidelines on management of acute coronary syndromes to people with haemophilia - an assessment by the ADVANCE Working Group.

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Staritz, Peter de Moerloose, Philippe Schutgens, Roger Dolan, Gerry ADVANCE Working Group Hermans, Cédric [UCL]

There are no evidence-based guidelines for antithrombotic management in people with haemophilia (PWH) presenting with acute coronary syndrome (ACS). The aim of the study was to review the current European Society of Cardiology guidelines, and to consider how best they should be adapted for PWH. Structured communication techniques based on a Delphi-like methodology were used to achieve expert consensus on key aspects of clinical management. The main final statements are as follows: (i) ACS and myocardial revascularization should be managed promptly by a multidisciplinary team that includes a haemophilia expert, (ii) each comprehensive care centre for adult PWH should have a formal clinical referral pathway with a cardiology centre with an emergency unit and 24 h availability of percutaneous coronary intervention (PCI), (iii) PCI should be performed as soon as possible under adequate clotting factor protection, (iv) bare metal stents are preferred to drug-eluting stents, (v) anticoagulants should only be used in PWH after replacement therapy, (vi) minimum trough levels should not fall below 5-15% in PWH on dual antiplatelet therapy, (vii) the duration of dual antiplatelet therapy after ACS and PCI should be limited to a minimum, (viii) the use of GPIIb-IIIa inhibitors is not recommended in PWH other than in exceptional circumstances, (ix) the use of fibrinolysis may be justified in PWH when primary PCI (within 90 min) is not available ideally under adequate clotting factor management. It is hoped that the results of this initiative will help to guide optimal management of ACS in PWH.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès restreint
Publication date 2013
Language Anglais
Journal information "Haemophilia : the official journal of the World Federation of Hemophilia" - Vol. 19, no.6, p. 833-840 (2013)
Peer reviewed yes
Publisher Blackwell Science ((United Kingdom) Oxford)
issn 1351-8216
e-issn 1365-2516
Publication status Publié
Affiliations UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire
UCL - (SLuc) Service d'hématologie
MESH Subject Acute Coronary Syndrome ; Anticoagulants ; Coagulants ; Drug-Eluting Stents ; Europe ; Factor VIII ; Hemophilia A ; Humans ; Platelet Aggregation Inhibitors ; Platelet Glycoprotein GPIIb-IIIa Complex ; Societies, Scientific
Keywords acute coronary syndrome ; anticoagulant ; antiplatelet ; antithrombotic ; haemophilia ; myocardial infarction
Links
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Bibliographic reference Staritz, Peter ; de Moerloose, Philippe ; Schutgens, Roger ; Dolan, Gerry ; ADVANCE Working Group ; et. al. Applicability of the European Society of Cardiology guidelines on management of acute coronary syndromes to people with haemophilia - an assessment by the ADVANCE Working Group.. In: Haemophilia : the official journal of the World Federation of Hemophilia, Vol. 19, no.6, p. 833-840 (2013)
Permanent URL http://hdl.handle.net/2078.1/208560