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Successful use of emicizumab in a patient with refractory acquired hemophilia A and acute coronary syndrome requiring percutaneous coronary intervention

ESSENTIALS: Acquired hemophilia A is a rare bleeding disorder often accompanied by other comorbidities. We describe emicizumab use in acquired hemophilia A complicated by acute coronary syndrome. Emicizumab proved safe and effective in a patient with acquired hemophilia A. Emicizumab facilitated suc...

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Autores principales: Dane, Kathryn E., Lindsley, John P., Streiff, Michael B., Moliterno, Alison R., Khalid, Mian K., Shanbhag, Satish
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611359/
https://www.ncbi.nlm.nih.gov/pubmed/31294330
http://dx.doi.org/10.1002/rth2.12201
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author Dane, Kathryn E.
Lindsley, John P.
Streiff, Michael B.
Moliterno, Alison R.
Khalid, Mian K.
Shanbhag, Satish
author_facet Dane, Kathryn E.
Lindsley, John P.
Streiff, Michael B.
Moliterno, Alison R.
Khalid, Mian K.
Shanbhag, Satish
author_sort Dane, Kathryn E.
collection PubMed
description ESSENTIALS: Acquired hemophilia A is a rare bleeding disorder often accompanied by other comorbidities. We describe emicizumab use in acquired hemophilia A complicated by acute coronary syndrome. Emicizumab proved safe and effective in a patient with acquired hemophilia A. Emicizumab facilitated successful administration of dual antiplatelet therapy. ABSTRACT: We report a patient with a high‐titer factor VIII inhibitor refractory to immunosuppression. He initially presented with myocardial infarction requiring percutaneous coronary intervention (PCI) with bare metal stent placement. Despite Feiba prophylaxis, inadequate hemostasis prompted premature discontinuation of dual antiplatelet therapy (DAPT). Fifteen weeks later, the patient presented with a left anterior descending artery in‐stent restenosis. This case report examines the Key Clinical Question of how to manage in‐stent restenosis in a patient with acquired hemophilia A (AHA). After multidisciplinary discussions including hematology, cardiology, cardiac surgery, laboratory medicine, and pharmacy, emicizumab was initiated to facilitate PCI. Four weeks after emicizumab initiation, the patient underwent successful PCI with drug‐eluting stent placement. Five months after discharge, he remains without signs or symptoms of cardiac disease or bleeding on DAPT and emicizumab. This case provides evidence of the potential of emicizumab for bleeding prophylaxis in AHA.
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spelling pubmed-66113592019-07-10 Successful use of emicizumab in a patient with refractory acquired hemophilia A and acute coronary syndrome requiring percutaneous coronary intervention Dane, Kathryn E. Lindsley, John P. Streiff, Michael B. Moliterno, Alison R. Khalid, Mian K. Shanbhag, Satish Res Pract Thromb Haemost Case Reports ESSENTIALS: Acquired hemophilia A is a rare bleeding disorder often accompanied by other comorbidities. We describe emicizumab use in acquired hemophilia A complicated by acute coronary syndrome. Emicizumab proved safe and effective in a patient with acquired hemophilia A. Emicizumab facilitated successful administration of dual antiplatelet therapy. ABSTRACT: We report a patient with a high‐titer factor VIII inhibitor refractory to immunosuppression. He initially presented with myocardial infarction requiring percutaneous coronary intervention (PCI) with bare metal stent placement. Despite Feiba prophylaxis, inadequate hemostasis prompted premature discontinuation of dual antiplatelet therapy (DAPT). Fifteen weeks later, the patient presented with a left anterior descending artery in‐stent restenosis. This case report examines the Key Clinical Question of how to manage in‐stent restenosis in a patient with acquired hemophilia A (AHA). After multidisciplinary discussions including hematology, cardiology, cardiac surgery, laboratory medicine, and pharmacy, emicizumab was initiated to facilitate PCI. Four weeks after emicizumab initiation, the patient underwent successful PCI with drug‐eluting stent placement. Five months after discharge, he remains without signs or symptoms of cardiac disease or bleeding on DAPT and emicizumab. This case provides evidence of the potential of emicizumab for bleeding prophylaxis in AHA. John Wiley and Sons Inc. 2019-04-09 /pmc/articles/PMC6611359/ /pubmed/31294330 http://dx.doi.org/10.1002/rth2.12201 Text en © 2019 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals, Inc on behalf of International Society on Thrombosis and Haemostasis. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Case Reports
Dane, Kathryn E.
Lindsley, John P.
Streiff, Michael B.
Moliterno, Alison R.
Khalid, Mian K.
Shanbhag, Satish
Successful use of emicizumab in a patient with refractory acquired hemophilia A and acute coronary syndrome requiring percutaneous coronary intervention
title Successful use of emicizumab in a patient with refractory acquired hemophilia A and acute coronary syndrome requiring percutaneous coronary intervention
title_full Successful use of emicizumab in a patient with refractory acquired hemophilia A and acute coronary syndrome requiring percutaneous coronary intervention
title_fullStr Successful use of emicizumab in a patient with refractory acquired hemophilia A and acute coronary syndrome requiring percutaneous coronary intervention
title_full_unstemmed Successful use of emicizumab in a patient with refractory acquired hemophilia A and acute coronary syndrome requiring percutaneous coronary intervention
title_short Successful use of emicizumab in a patient with refractory acquired hemophilia A and acute coronary syndrome requiring percutaneous coronary intervention
title_sort successful use of emicizumab in a patient with refractory acquired hemophilia a and acute coronary syndrome requiring percutaneous coronary intervention
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611359/
https://www.ncbi.nlm.nih.gov/pubmed/31294330
http://dx.doi.org/10.1002/rth2.12201
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