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Revascularization strategies and in-hospital management in acute coronary syndromes complicated by hemophilia A or hemophilia B

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<br></br>Among adult patients with hemophilia A and hemophilia B the emergent management of acute coronary syndromes (ACSs) is challenging, and exposure to antithrombotic agents and/or revascularization procedures may confer an enhanced risk of bleeding. We sought to identify clinical characteristics and in-hospital outcomes among ACS patients with hemophilia A/hemophilia B, compared with matched noncoagulopathic ACS controls. Case discharges from the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (1998–2011) had International Classification of Diseases, 9th Revision codes for hemophilia A/hemophilia B and ACS. Control discharges were matched to cases by year of discharge and hospital. Discharges in both groups were assessed for cardiovascular risk factors, type of ACS, use of coronary artery bypass grafting, percutaneous coronary intervention (PCI), bare-metal stent and/or drug-eluting stent, bleeding, and death. In total, 237 cases and 148 848 matched controls were identified. Among cases, HIV/Hepatitis C positivity was more common and obesity/hyperlipidemia less common. ST-elevation myocardial infarction (STEMI) occurred less frequently among hemophilia A cases than controls. hemophilia A and hemophilia B cases were more likely to be managed medically. Cases treated with coronary stent placement were more likely to receive a bare-metal stent than controls. Among PCI, bleeding was more common among hemophilia A cases. The death rates were comparable between groups. ACS–hemophilia A/hemophilia B cases were more often treated noninvasively compared with controls, suggesting an avoidance of PCI/coronary artery bypass grafting in this population, and bleeding (among hemophilia A) was more common. These findings support further study of the management of ACS and in-hospital outcomes among individuals with hemophilia. </div> <div id="Refs" class="tab-pane"> No Reference information available - sign in for access. </div> <div id="Cits" class="tab-pane"> No Citation information available - sign in for access. </div> <div id="Supp" class="tab-pane"> No Supplementary Data. </div> <div id="Data" class="tab-pane rs_skip">No Article Media</div> <div id="Metr" class="tab-pane rs_skip">No Metrics</div> </div> <div id="Info"> <p><strong>Keywords:</strong> <a href="/search;jsessionid=4ptl309nndq52.x-ic-live-03?option1=keywords&value1='acute+coronary+syndromes'">acute coronary syndromes</a>; <a href="/search;jsessionid=4ptl309nndq52.x-ic-live-03?option1=keywords&value1='bleeding'">bleeding</a>; <a href="/search;jsessionid=4ptl309nndq52.x-ic-live-03?option1=keywords&value1='hemophilia+A'">hemophilia A</a>; <a href="/search;jsessionid=4ptl309nndq52.x-ic-live-03?option1=keywords&value1='hemophilia+B'">hemophilia B</a>; <a href="/search;jsessionid=4ptl309nndq52.x-ic-live-03?option1=keywords&value1='in-hospital+outcomes'">in-hospital outcomes</a> </p> <p><strong>Document Type:</strong> Research Article</p> <p><strong>Affiliations:</strong> <strong id="aff_1">1: </strong> <span id="aff_ Department of Medicine, University of Pennsylvania Health System _contents"> Department of Medicine, University of Pennsylvania Health System </span> <strong id="aff_2">2: </strong> <span id="aff_ Department of Biostatistics, Epidemiology and informatics, University of Pennsylvania _contents"> Department of Biostatistics, Epidemiology and informatics, University of Pennsylvania </span> <strong id="aff_3">3: </strong> <span id="aff_ Cardiovascular Division, Penn Presbyterian Medical Center _contents"> Cardiovascular Division, Penn Presbyterian Medical Center </span> <strong id="aff_4">4: </strong> <span id="aff_ Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA _contents"> Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA </span> <strong id="aff_5">5: </strong> <span id="aff_ Department of Biostatistics, Epidemiology and informatics, University of Pennsylvania, Phyllis A. Gimotty and Patrick F. Fogarty contributed equally to this article. _contents"> Department of Biostatistics, Epidemiology and informatics, University of Pennsylvania, Phyllis A. Gimotty and Patrick F. Fogarty contributed equally to this article. </span> <strong id="aff_6">6: </strong> <span id="aff_ Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA, Phyllis A. Gimotty and Patrick F. Fogarty contributed equally to this article., Address where work was carried out. Present address: 500 Arcola Road, Collegeville, PA 19426, USA._contents"> Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA, Phyllis A. Gimotty and Patrick F. Fogarty contributed equally to this article., Address where work was carried out. Present address: 500 Arcola Road, Collegeville, PA 19426, USA.</span> </p> <p>Publication date: December 1, 2017</p> <script type="text/javascript"> $(document).ready(function() { const MAGIC_LENGTH = 350; var shortdescription = $(".originaldescription").text().replace(/\\&/g, '&').replace(/\\</g, '<').replace(/\\>/g, '>').replace(/\\t/g, '   ').replace(/\\n/g, '<br />'); if (shortdescription.length > MAGIC_LENGTH) { shortdescription = "<span class='shortdescription'>" + shortdescription.substring(0, MAGIC_LENGTH - 100) + "... <a href='#'>more</a></span>"; } $(".descriptionitem").prepend(shortdescription); $(".shortdescription a").on("click", function(e) { e.preventDefault(); $(".shortdescription").hide(); $(".originaldescription").slideDown(); }); }); </script> </div> <div id="trendmd-suggestions"></div> <script type="application/json" class="js-hypothesis-config">{ "openSidebar": false }</script> <script async src="https://hypothes.is/embed.js"></script> <div class="advertisingbanner 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