A case report of the coagulation management of an adult with moderate haemophilia A undergoing transcatheter aortic valve implantation

Background Haemophilia A is an X-linked bleeding disorder resulting from factor VIII deficiency. While surgical management requires the correction of factor VIII levels by the administration of factor VIII concentrate, antiplatelet therapy after lower-risk cardiac surgery/procedures (such as transcatheter aortic valve implantation - TAVI) is not yet standardised. This report describes the management of a patient with moderate haemophilia A undergoing TAVI for severe aortic stenosis.. Case summary A 76-year-old man with untreated haemophilia A was admitted with traumatic bleeding. After initial stabilisation, he developed acute heart failure due to newly discovered severe aortic stenosis. TAVI procedure was performed by transfemoral access according to multidisciplinary team-discussion; a bio-prosthetic valve was successfully implanted. We outline the periprocedural haemostatic management, which included factor VIII replacement therapy to achieve guideline-recommended activity levels, followed by progressive dose reduction. In view of the high bleeding risk and absence of significant coronary artery disease, antiplatelet therapy was limited to a short course. The procedure was successful, with no bleeding complications. Conclusion Although evidence is limited to case reports, TAVI appears to be feasible and safe in patients with haemophilia A. Maintaining high factor VIII activity levels and minimizing antithrombotic exposure through multidisciplinary evaluation can effectively reduce haemorrhagic risk. Our case, in line with previous reports, resulted in no bleeding complications.