Among patients with hemophilia who undergo percutaneous coronary intervention (PCI), a subtle approach to the management of acute coronary syndrome (ACS) is critical, according to findings from a retrospective cohort study published in Catheterization and Cardiovascular Interventions.
Although hemophilia has traditionally been linked to declines in life expectancy because of the inherent risk for life-threatening bleeding complications, treatment advancements over the past few decades have greatly improved patients’ life expectancy. With the hemophilia population thus surviving longer, an elevated risk for cardiovascular disease and ACS are being reported among older individuals with the disorder. Studies have revealed that circulatory disease is the second most common cause of death among US patients with hemophilia.
The management and treatment of ACS in patients with hemophilia are particularly challenging because antiplatelet therapy and anticoagulation, which are considered the standard of care, are known to exacerbate the risk for bleeding. This, in turn, has led to the use of PCI and cardiac catheterization as the preferred treatment strategy.
Recognizing the need for dedicated management strategies and comprehensive care in persons with hemophilia, the researchers sought to evaluate the major adverse outcomes, length of hospitalization, and mortality rates among individuals with hemophilia who present with ACS and subsequently undergo PCI.
Data derived from the 2018 Nationwide Inpatient Sample Database, which is part of the Healthcare Cost and Utilization Project, were used to explore the outcomes of ACS management with PCI in adults with and those without hemophilia. Patients with significant comorbidities were excluded from the analysis.
A total of 239,900 individuals with ACS who underwent cardiac catheterization were identified by the Nationwide Inpatient Sample database in 2018, which included 211 patients with hemophilia. The hemophilic cohort was younger than the nonhemophilia patients (64.2±15.6 years vs 68.5±13.8 years, respectively; P <.001) and had a higher percentage of White patients (79.2% vs 72.7%, respectively; P <.001).
Results of the study demonstrated that the rates of gastrointestinal bleeding (11.0% vs 2.8%, respectively); hemorrhagic stroke (10.0% vs 1.4%, respectively), and retroperitoneal hemorrhage (5.6% vs 1.4%, respectively) all were significantly higher in patients with hemophilia who underwent PCI compared with the nonhemophilia group who underwent the procedure (P <.001 for all).
Moreover, among those in the hemophilia cohort, the incidence of venous thromboembolism was statistically significantly higher compared with the incidence among those in the nonhemophilia cohort (6.6% vs 2.4%, respectively; P =.027).
As anticipated, the length of hospital stay was significantly higher among those with hemophilia compared with those without hemophilia (4 days [range, 2-7 days] vs 3 days [range, 2-4 days]; P <.001). A significantly higher rate of mortality also was reported in the hemophilia arm compared with the nonhemophilia arm (7.1% vs 3.3%, respectively; P =.037).
“To mitigate the risk [for] unfavorable outcomes [in patients with hemophilia undergoing PCI], it is crucial to ensure adequate replenishment of coagulation factors and [to] establish close collaboration between cardiologists and hematologists,” the authors concluded.
This article originally appeared on Rare Disease Advisor
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