Applicability of the European Society of Cardiology Guidelines on the management of acute coronary syndromes to older people with haemophilia A – A modified Delphi consensus by the ADVANCE Working Group

Introduction: As people with haemophilia (PWH) receive better treatment and live longer they are more likely to encounter cardiovascular disease (CVD) and other comorbidities. ESC guidelines for the acute management of patients presenting with acute coronary syndrome (ACS) are based on the non-haemophilia population. Aim: To review the guidelines and propose relevant adaptations for PWHA without inhibitors who are treated with prophylaxis and present with ACS. Methods: As part of the ADVANCE Group, 20 European haemophilia experts used a modified Delphi approach to develop and gain consensus on proposed adaptations of the ESC guidelines for PWHA without inhibitors. Results: Of the 32 Class I recommendations across both guidelines, adaptions were considered necessary and proposed for 15. The adaptions highlight the need to provide sufficient FVIII trough levels at the time of antithrombotic treatment in people with haemophilia A (HA) without inhibitors. Patients receiving emicizumab prophylaxis and requiring oral anticoagulation therapy or combined single antiplatelet plus oral anticoagulation therapy will require additional FVIII replacement therapy. Conclusion: In the absence of high-quality clinical evidence, the combined expert opinion used to develop these adaptions to the current ESC guidelines may help to guide clinicians in their treatment decisions when a PWHA presents with ACS.

Ay, CihanMedical University of Vienna (författare)
De Moerloose, PhilippeUniversity of Geneva Medical School (författare)
Fontana, PierreGeneva University Hospital (författare)
Windyga, JerzyInstitute of Haematology and Transfusion Medicine, Warsaw (författare)
Astermark, JanSkåne University Hospital(Swepub:lu)medf-jas (författare)
Berntorp, ErikLund University,Lunds universitet,Klinisk koagulationsmedicin, Malmö,Forskargrupper vid Lunds universitet,Clinical Coagulation, Malmö,Lund University Research Groups(Swepub:lu)medf-ebe (författare)
Carvalho, Manuela (författare)
Dolan, GerardSt Thomas' Hospital (författare)
Hermans, CedricSaint-Luc University Hospital (författare)
Holme, Pål AndreOslo university hospital (författare)
Kenet, GiliTel-Aviv University (författare)
Mancuso, Maria Elisa (författare)
Marquardt, NataschaUniversity Hospital Bonn (författare)
Nunez, RamiroUniversity Hospital Virgen del Rocío (författare)
Pabinger, IngridMedical University of Vienna (författare)
Rodgers, RyanGlasgow Royal Infirmary (författare)
Valk, Paul van derUniversity Medical Center Utrecht (författare)
Yuste, Victor JimenezUniversity Hospital La Paz (författare)
Zupan, Irena PreložnikUniversity Medical Centre Ljubljana (författare)
Vivantes hospital im FriedrichshainMedical University of Vienna (creator_code:org_t)

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Hematologi

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