Department of Cardiology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea.
Department of Cardiology, Cardiovascular Center, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
Yonsei Med J. 2024 Dec;65(12):777-780. doi: 10.3349/ymj.2023.0577.
A 55-year-old male with hemophilia A came to the outpatient clinic with chest pain for several days after overdose injection of coagulation factor. He was a heavy smoker and a chronic alcoholic. An electrocardiogram (ECG) showed no specific change. A coronary computed tomography showed moderate stenosis with soft plaque at the distal segment of right coronary artery. His pain was improved with antianginal and reflux medications. Twenty days later, he ran to the emergency room complaining of squeezing chest pain. ECG showed mild ST segment elevation in inferior territories. Invasive coronary angiography via right radial artery revealed severe thrombotic occlusion at the same lesion. A bare metal stent was deployed and dual antiplatelet therapy including aspirin and clopidogrel had been maintained for 6 months under the conventional hemophilia management. The patient did not develop any coronary events just with single clopidogrel therapy for 5 years until he passed away from pancreatic cancer. Our case implicates that the invasive coronary intervention and post-procedural management could be safely performed with conventional standards of care while maintaining the usual dose of coagulation factors in a hemophilia patient with acute coronary syndrome.
一位 55 岁的男性血友病 A 患者，因凝血因子过量注射后出现胸痛数天，来到门诊。他是一名重度吸烟者和慢性酗酒者。心电图（ECG）无特异性改变。冠状动脉计算机断层扫描显示右冠状动脉远端节段中度狭窄伴软斑块。他的疼痛在使用抗心绞痛和反流药物后得到改善。20 天后，他因挤压性胸痛跑到急诊室。心电图显示下壁导联轻度 ST 段抬高。通过右侧桡动脉进行的冠状动脉介入治疗显示同一病变处严重血栓闭塞。放置了一个裸金属支架，在常规血友病管理下，他已经接受了 6 个月的阿司匹林和氯吡格雷双联抗血小板治疗。该患者在接受急性冠状动脉综合征常规标准治疗的同时，仅用氯吡格雷单一药物治疗 5 年，未发生任何冠状动脉事件，直到因胰腺癌去世。我们的病例提示，在维持血友病患者凝血因子常规剂量的情况下，侵入性冠状动脉介入治疗和术后管理可以安全地按照常规标准进行。
