A case report of acute inferior myocardial infarction in a patient with severe hemophilia A after recombinant factor VIII infusion

Zupančić-Šalek, Silva and Vodanović, Marijo and Pulanić, Dražen and Skorić, Boško and Matytsina, Irina and Klovaite, Jolanta (2017) A case report of acute inferior myocardial infarction in a patient with severe hemophilia A after recombinant factor VIII infusion. Medicine, 96 (52). e9075. ISSN 0025-7974

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Abstract

RATIONALE: The extent of protective effects of hemophilia against thrombotic events such as myocardial infarction (MI) and other acute coronary syndromes remains to be determined, as major risk factors for cardiovascular disease exist despite factor VIII (FVIII) deficiency. We present a case report of a 41-year-old male with severe hemophilia A and several cardiovascular risk factors. ----- PATIENT CONCERNS: This morbidly obese patient developed chest pressure, followed by chest pain and difficulty in breathing shortly after receiving on-demand treatment with intravenous recombinant FVIII (rFVIII) (turoctocog alfa) dosed per body weight. ----- DIAGNOSES: An electrocardiogram revealed a diagnosis of inferior ST-segment elevation MI. ----- INTERVENTIONS: The patient underwent an urgent coronary angiography using a radial artery approach. During the next 12 months, he received dual antiplatelet treatment, acetylsalicylic acid 100 mg, and clopidogrel 75 mg daily. His treatment for severe hemophilia A was changed to plasma-derived FVIII replacement therapy. -----OUTCOMES: During this 12-month period, he experienced several small bleeds in his elbows. ----- CONCLUSIONS: The temporal relationship between rFVIII infusion and onset of the MI suggests a possible association; however, apart from obesity, the patient also had other major risk factors for arterial thrombosis, such as hypertension and smoking. Furthermore, atherosclerotic disease and underlying atherosclerotic changes could not be excluded with certainty. This case highlights the importance of studies assessing the impact of excess body weight on rFVIII dosing.

Item Type: Article
Additional Information: Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NCND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
MeSH: Adult ; Factor VIII/therapeutic use ; Hemophilia A/complications ; Hemophilia A/drug therapy ; Humans ; Inferior Wall Myocardial Infarction/diagnosis ; Inferior Wall Myocardial Infarction/etiology ; Male ; Obesity, Morbid/complications
Departments: Katedra za internu medicinu
Depositing User: Anja Majstorović
Status: Published
Creators:
CreatorsEmail
Zupančić-Šalek, SilvaUNSPECIFIED
Vodanović, MarijoUNSPECIFIED
Pulanić, DraženUNSPECIFIED
Skorić, BoškoUNSPECIFIED
Matytsina, IrinaUNSPECIFIED
Klovaite, JolantaUNSPECIFIED
Date: December 2017
Date Deposited: 07 Jun 2019 06:54
Last Modified: 20 Aug 2020 09:58
Subjects: /
Related URLs:
URI: http://medlib.mef.hr/id/eprint/3255

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