Haemophilia and acute coronary syndrome – should we still be afraid, should we avoid new antiplatelet drugs?

Due to increased life expectancy and unfavorable cardiovascular risk profile in persons with haemophilia (PWH), physicians may face the problem of using potentially contraindicated antiplatelet drugs in this vulnerable to bleedings group of patients. Current European guidelines recommend usage of dual antiplatelet therapy (DAPT) for 12 months after acute coronary syndrome (ACS), whereas haemophilia specialists suggest that such aggressive treatment should be limited to a minimum. The aim of our case report was to assess whether ticagrelor could be a component of DAPT in PWH presenting ACS. We present the case of 67-years-old male with severe haemophilia A and ST-segment elevation myocardial infarction, who required percutaneous coronary intervention with implantation of 5 drug-eluting stents (DES). Due to high risk of stent thrombosis, after thorough discussion with hematologist, we decided to treat the patient with ticagrelor, acetylsalicylic acid and prophylactic doses of factor VIII. Recommended treatment was well tolerated, without angina and bleeding episodes during follow-up. In our opinion usage of DES and extended DAPT with ticagrelor may be considered in PWH and ACS with elevated risk of restenosis. Concomitant prophylactic doses of clotting factors should ensure the safety of the treatment used as in the general population.