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

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.