Efficacy of Replacement and Anti-Platelet Therapies in a Patient with Severe Haemophilia A Undergoing Percutaneous Coronary Stent Implantation

Abstract

Introduction: Severe haemophilia A is characterized by serious factor VIII deficiency (biological activity <1%) resulting in frequent spontaneous haemorrhage and abnormal bleeding after minor injury, surgery or tooth extraction.

Patient and methods: We report the case of a 58-year-old patient with severe haemophilia A without inhibitors but with other comorbidities (HCV and HIV seroconversion), who underwent coronary angioplasty and stent implantation after acute myocardial infarction.

Results: Compared with previous therapy, Nuwiq^® led to a reduction of about 20% in drug consumption (360,000 IU vs 540,000 IU per year) and in the annualized bleeding rate (ABR) (5 vs 15).

Discussion: Pharmacokinetic-guided personalized prophylaxis with Nuwiq^® provided bleeding protection with good tolerability and a satisfactory pharmacokinetic profile in a patient with severe haemophilia A and comorbidities whose replacement therapy had to be adjusted because of other contraindicated treatment.

Learning points: Haemophilia A is characterized by frequent haemorrhage.Pharmacokinetic-guided personalized prophylaxis with Nuwiq^® provided bleeding protection with good tolerability.Nuwiq^® leads to a reduction of about 20% in both drug consumption and the annualized bleeding rate.

Keywords: Haemophilia A; Nuwiq®; coronary stent; personalized prophylaxis; pharmacokinetics; recombinant FVIII.