Multidisciplinary Team Management of Severe Hemophilia A with Non-ST Elevation Myocardial Infarction

Elderly patients with hemophilia A have an increased risk of age-related thrombotic diseases, such as myocardial infarction. The relevant risk factors are comparable to those in the normal elderly population. However, their diagnosis and treatment are difficult. We report a case of a 53-year-old man with severe hemophilia A who presented with non-ST elevation myocardial infarction (NSTEMI), and this is the first report of successful treatment of such a patient in China. The patient presented with chest tightness, palpitations, and dyspnea after excessive alcohol consumption. He developed hypotension and shock, which rapidly progressed to respiratory and cardiac arrest and loss of consciousness. Immediate cardiopulmonary resuscitation was initiated, along with respiratory and cardiovascular management. Hematologic management with factor VIII (FVIII) replacement therapy and concurrent aspirin coupled with enoxaparin sodium, were also employed. As the patient's condition was diagnosed as acute NSTEMI, a percutaneous coronary intervention was not performed. The patient showed significant improvement after 1 month; he was able to walk independently and was discharged. Based on the medication order, the patient was continuously treated with FVIII prophylaxis, clopidogrel tablets, and atorvastatin tablets after discharge to prevent the recurrence of cardiovascular events. The acute coronary syndrome incidence rate is similar in patients with hemophilia and the general population. Multidisciplinary collaborative management is required. The multidisciplinary team needs to develop its diagnosis and treatment process flow, and treatment should be individualized using or anticoagulation/antiplatelet therapy based on the patient's medical history.