Abstract Number: PB0649
Meeting: ISTH 2021 Congress
Background: The life expectancy of people with hemophilia (PWH) has been increasing. Age-related conditions became a challenge, including the management of thrombotic diseases, to minimize the bleeding risk and ensure sufficient anticoagulation and antiaggregation.
Aims: Present a case report to highlight the issues associated with treatment of PWH with thrombotic events, complicated by hemorrhage.
Methods: A 76-year-old male with moderate hemophilia A (FVIII-4%) with history of dyslipidemia, acute myeloid leukemia and amputation of inferior lower limb due to pseudo-tumor, came into the emergency department (ED) on January 2021, due to left hemiparesis and dysarthria. He underwent endovascular revascularization under factor replacement therapy. After discharge, double antiaggregation (acetylsalicylic acid and ticagrelor) was decided as he had a new stenosis of cerebral vessels. Three weeks later, he went into the ED of local hospital, due to a tongue bite with a small hematoma and swelling on site and was discharged with indication to apply ice and cold diet. As the edema and hematoma increased, he returned to that hospital. In this moment, reference center was contacted and patient was transferred.
Results: On admission into the ED, he presented edema of tongue with active bleeding and inframandibular/upper neck hematoma. He initiated FVIII concentrate and after evaluation by otorhinolaryngology, an oozing bleeding was observed and nasotracheal intubation was performed to protect airway. In intensive care unit, the patient needed packed red blood cells transfusion and FVIII replacement. FVIII levels, hemorrhagic manifestations and thrombotic risk were evaluated in order to guide further treatment. He was discharged with only aspirin and secundary prophylactic treatment.
Conclusions: The optimal treatment to manage PWH needing antithrombotic therapy remains a challenge. It is important to be aware of the bleeding phenotype of the patient, factor level and thrombotic risk, debating all these factors in a multidisciplinary team in order to delineate the best strategy.
To cite this abstract in AMA style:Teixeira S, Machado I, Gonçalves D, Silva JP, Fernandes S, Lopes M, Carvalho M, Aranda D, Koch C. From Stroke Treatment, through a Tongue Bite, until Intensive Care Unit: The Challenge of Antithrombotic Treatment in People with Haemophilia. A Case Report [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/from-stroke-treatment-through-a-tongue-bite-until-intensive-care-unit-the-challenge-of-antithrombotic-treatment-in-people-with-haemophilia-a-case-report/. Accessed October 1, 2023.
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