Successful multi-vessel percutaneous coronaryintervention for acute coronary syndrome in a severeTaiwanese hemophiliac with HIV infection underHARRT: the first reported case in Chinese population

Background:Most of the limited studies on acute coronary syndrome(ACS) of patients with hemophilia (PWH) came from the West coun-tries, and experience originated from Asian is few.Aims:We report the first case of Taiwanese PWH with ACS, receivingsuccessful multi-vessel percutaneous coronary intervention (PCI) withbare metal stents (BMS).Methods:A 56-year-old Taiwanese with severe-type hemophilia A hadhis past history of his hypertension, NIDDM, hemophilic arthropathyof his knees and ankles, and renal stones. He had HIV infection underHARRT and smoked 20 cigarettes day1for 30 years.Results:Angina happened to him in the early 2012, and he was advisedof taking Aspirin 100 mg daily. Since July 2013, angina and dyspneahad sometimes occurred. Thallium 201 myocardial perfusion scanrevealed severe myocardial ischemia with transient ischemic dilatationsign. However, he had been refusing treatment, except Aspirin-taking.He finally received PCI via right radial artery access due to terribleangina on 25 December, 2014. Before PCI, a loading dose of 8000 IUheparin with Clopidogrel 300 mg and Aspirin 300 mg was prescribed;Meanwhile, the FVIII trough level was kept≥80% for the following48 h. Totally BMS were deployed over the middle and distal segmentof left circumflex coronary artery, the ostium of left anterior descend-ing artery, the posterior-lateral branch and proximal segment of rightcoronary artery. After PCI, Clopidogrel 75 mg with Aspirin 100 mgonce daily for 2 months were planned, with keeping the FVIII troughlevel≥20%. No complication was found. However, gross hematuriaonce and intramuscular hemorrhage once happened during dual anti-platelet therapy, and no more bleeding episode occurred after adjust-ing FVIII trough level to≥25%.Conclusion:Under the support of FVIII replacement, PWH could tol-erate peri-PCI procedures and medications safely. FVIII trough levelmight need to be adjusted during dual antiplatelet therapy if thepatient has extra underlying predisposing factors for bleeding.Disclosure of Interest:None declared