Cardiac Surgery and Percutaneous Coronary Interventions in Patients with Hemophilia B: an Overview of Published Reported Cases

Review Article

Cardiac Surgery and Percutaneous Coronary Interventions in Patients with Hemophilia B: an Overview of Published Reported Cases

F Elizabeth Krakow ^{1 2}, Ruslan Ganchev ³ and AM Julia Anderson ^{1 3}

Affiliations: Departments of ¹Medicine and ²Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada and ³Department of Haematology, Royal Infirmary of Edinburgh, Edinburgh, UK

Submission date: 27th July 2009, Revision date: 1st September 2009, Acceptance date: 7th September 2009


ABSTRACT

With an ageing hemophilia population and decreasing mortality from transfusion‐transmitted viruses, it is likely that percutaneous coronary interventions and surgery for coronary artery disease and valvular heart disease will become more commonplace. Eighteen reports of cardiac surgery and coronary interventions in patients with hemophilia B are published, and although limited in number and heterogeneous in nature, they represent the available published experience of this complex and evolving field. Cardiac surgery appears to be feasible and safe in individuals with all severities of hemophilia B, but the optimal factor replacement schedule remains uncertain, and there is a lack of consensus on the minimal target factor IX (FIX) level to attain peri‐ and postoperatively, in addition to the duration of replacement therapy, the use of antifibrinolytic agents, and the use of antithrombotic therapies following surgery. Close cooperation and good communication between all members of a multidisciplinary team are necessary for successful outcome, and an individualized written protocol is highly recommended. For individuals with hemophilia B undergoing coronary intervention, the bleeding risk for patients with different severities of hemophilia B requiring dual antiplatelet therapies after angioplasty and stent insertion is unclear, and the use of antithrombotic therapies pre‐, peri‐ and post‐procedure remains unknown. The aim of this overview is to detail key aspects of the management of patients with hemophilia B undergoing cardiac surgery and percutaneous coronary interventions to enable informed decision‐making for individual patients in the future and to assist in the development of future management recommendations.

Keywords: percutaneous coronary intervention, cardiac surgery, hemophilia B
Correspondence: Julia A M Anderson, Department of Clinical and Laboratory Haematology, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, UK