Outcome of Aortocoronary Bypass in a Patient with a History of Hemophilia

H emophilia is a congenital disease of the blood coagulation system, linked to the X chromosome, and develops with a deficiency of blood clotting factor VIII (hemophilia type A) or factor IX (hemophilia type B).The number of people with hemophilia in the world is about 400,000 people [1] .In Russia, there are about 7,500 people with hemophilia [2] .It was previously believed that the presence of hemophilia protects against the occurrence of coronary heart disease [3] .However, subsequently published studies have shown that with improved treatment of hemophilia, the life expectancy of these patients increases, and the number of risk factors and concomitant diseases, including coronary artery disease, also increases [4] .Indeed, in a study conducted in Canada on 294 hemophilia patients, arterial hypertension was found in 30.3%, diabetes in 10.5%, and dyslipidaemia in 22.4%.Hemophilia is a congenital disorder of the blood coagulation system linked to the X chromosome and manifested by a deficiency of blood coagulation factor VIII (hemophilia type A) or factor IX (hemophilia type B).We present our clinical case involving the combination of myocardial infarction (MI) and hemophilia type A. A 42-year-old man with a known history of hemophilia A was admitted to the emergency department of an external center with complaints of pressing chest pain radiating to the left arm.He was treated with 300 mg of ecopyrine and 300 mg of Plavix, and a significant increase in troponin level was detected.The patient was then transferred to the emergency department of our hospital.In the emergency department, he was evaluated by cardiology.The control troponin level was 72, and the patient was admitted to the coronary intensive care unit with a preliminary diagnosis of non-ST elevation myocardial infarction (NSTEMI).Coronary angiography was planned.Internal medicine and hematology clinics were consulted to adjust anticoagulant therapy for the procedure, and dual antiplatelet therapy (ecopyrine + Plavix) was administered.After coronary angiography, the patient was evaluated by a joint council of cardiovascular surgery and cardiology, and coronary bypass surgery was recommended.He was transferred to the cardiovascular surgery unit for preoperative preparation.During this period, he was also evaluated by the hematology clinic due to his hemophilia A history.Based on the clinic's recommendation, specific factor VIII (FVIII) therapy was administered pre-and postoperatively, along with daily aPTT monitoring.No complications occurred during surgery.Cardiopulmonary bypass was initiated once the activated clotting time (ACT) exceeded 450.No bleeding complications were observed in the postoperative period.The patient was successfully discharged.