A patient with acquired hemophilia A induced by clopidogrel

Hwang, Hye Won; Kong, Jee Hyun; Yu, Dong Wook; Kim, Woo Taek; Kim, Hyun Soo; Lee, Chong In

doi:10.5045/kjh.2012.47.1.80

Cited by 9 publications

(11 citation statements)

References 14 publications

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“…Since this review was published two more cases have been reported, including one during treatment with rivaroxaban [1] and another one of clopidogrel-induced haemophilia A [5]. Our patient is the first reported case of acquired haemophilia A while receiving apixaban.…”

Section: Referencesmentioning

confidence: 81%

“…In a review article of drug-induced acquired haemophilia A, a total of 34 cases were identified, mostly related to a variety of agents including antibiotics (four cases); psychiatric/neuroleptic (eight cases); interferon (11 cases); fludarabine (four cases); clopidogrel (five cases); other (two cases) [4]. Since this review was published two more cases have been reported, including one during treatment with rivaroxaban [1] and another one of clopidogrel-induced haemophilia A [5]. Our patient is the first reported case of acquired haemophilia A while receiving apixaban.…”

Section: Referencesmentioning

confidence: 99%

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Acquired haemophilia and the New Oral Anticoagulants (NOACs): coincidence or drug‐induced adverse event?

Kanellopoulou¹,

Alexopoulou²,

Nomikou³

2015

Haemophilia

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metal stents is not significantly different to those receiving drug-eluting stents [6].The duration of antiplatelet therapy with bare metal stents is controversial. In this case, the patient was given dual anitplatelet therapy for 2 months on the basis that the time for endothelization of a bare metal stent is approximately 4 weeks [7]. After discussions with cardiology colleagues, it was decided to use aspirin and ticagrelor. This was because the PLATO study showed a significant reduction in mortality from vascular causes, myocardial infarction or stroke with ticagrelor compared to clopidogrel (9.8% vs. 11.7% at 12 months; P = <0.001) without a significant risk in major bleeding (11.6% vs. 11.2%; P = 0.43) [8]. Additionally a small number of AH cases have been noted secondary to clopidogrel [9]. Aspirin was continued as patients with mild or moderate haemophilia often tolerate low-dose aspirin without the need for prophylaxis [4]. Such patients must however be closely followed up for any increased bleeding and if this occurs, anitplatelets should be stopped. A trough level of approximately 30% of FVIII is usually recommended for antiplatelet or anticoagulant therapy in patients with haemophilia to minimize bleeding issues [4].Here we present an unusual case of an AH patient presenting with acute coronary event. Previously reported cases of myocardial infarction in AH patients have been noted with the use of haemostatic agents [2]. A review of the literature revealed only one case of unsuspected AH in a patient with myocardial infarction [10]. Interestingly, this patient became symptomatic with extensive bruising and anaemia after being given clopidogrel which has been associated with cases of AH [9]. In our case, no specific treatment for AH was given since the risk of bleeding from the procedure was low and the risk of thrombosis with haemostatic agents was a clear concern.Disclosures The authors stated that they had no interests which might be perceived as posing a conflict or bias. References1 Collins PW, Hirsch S, Baglin TP et al.; UK Haemophilia Centre Doctors' Organisation. Acquired haemophilia A in the United Kingdom: a 2-year national surveillance study by the United Kingdom Haemophilia Centre Doctors' Organisation. Blood 2007; 109: 1870-7. 2 Baudo F, Collins P, Huth-K€ uhne A et al. Management of bleeding in acquired haemophilia A: results from the European Acquired Haemophilia (EACH2) Registry. Blood 2012; 120: 39-46. 3 Tang M, Wierup P, Terp K, Ingerslev J, Søren-sen B. Cardiac surgery in patients with haemophilia. Haemophilia 2009; 15: 101-7. 4 Schutgens REG, Tuinenburg A, Roosendaal G, Guyomi SH, Mauser-Bunschoten EP. Treatment of ischaemic heart disease in haemophilia patients: an institutional guideline. Haemophilia 2009; 15: 952-8. 5 Bovenzi F, De Luca L, Signore N, Fusco F, de Luca I. Abciximab for the treatment of an acute thrombotic coronary occlusion during stent implantation in a patient with severe hemophilia B. Ital Heart J 2003; 4: 728-30. 6 Malenka DJ, Kaplan AV, Lucas FL, Sharp SM, Skin...

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Section: Referencesmentioning

confidence: 81%

Section: Referencesmentioning

confidence: 99%

Acquired haemophilia and the New Oral Anticoagulants (NOACs): coincidence or drug‐induced adverse event?

Kanellopoulou¹,

Alexopoulou²,

Nomikou³

2015

Haemophilia

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“…The most commonly reported causes of AFVI include malignancies, autoimmune diseases, infections, and certain medications, especially antibiotics such as β-lactam antibiotics [1, 4]. In some patients, acquired hemophilia A, a rare disorder resulting from autoantibodies against coagulant factor VIII, was reported to develop following the initiation of oral antiplatelet drugs [9, 10]. To our knowledge, this is the first report of AFVI that might have been caused by the oral antiplatelet drug prasugrel.…”

Section: Discussionmentioning

confidence: 99%

Acquired Factor V Inhibitor with Hemorrhagic Symptoms after Prasugrel Hydrochloride Treatment

Sakatoku¹,

Takakuwa²,

Miura³

et al. 2019

Acta Haematol

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Acquired factor V inhibitor (AFVI) is a rare coagulopathy. It may be triggered by specific antigens such as antibiotics. We herein report the first case of AFVI after treatment with prasugrel hydrochloride (prasugrel) in an 80-year-old male who underwent percutaneous coronary intervention because of angina pectoris 6 years ago and was initiated on aspirin and ticlopidine hydrochloride. He was switched from ticlopidine hydrochloride to prasugrel before undergoing percutaneous coronary intervention for myocardial infarction. Fifteen days later, he developed sudden nasal hemorrhage, hematuria, and systemic purpura. Coagulation tests revealed prolonged prothrombin time-international normalized ratio (11.35) and activated partial thromboplastin time (170 s). The coagulation factor profile revealed a decreased FV activity (1%). The Bethesda assay for FV inhibitor was positive. AFVI was diagnosed; prasugrel was immediately discontinued, and administration of recombinant activated factor VII and prednisolone were initiated. Hemorrhagic symptoms immediately disappeared; FV activity improved, and the FV inhibitor titer was normalized.

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“…Moreover, drugs such as clopidogrel or warfarin might well mask the correct diagnosis of AHA. [5][6][7][8][9][10] Therefore, some authors suggest that for elderly patients on clopidogrel or warfarin therapy presenting with unusual/unexplained bleeding, not only the treatment but also the possibility of AHA should be carefully investigated. 7 Ticagrelor, the first reversible oral P2Y12 receptor antagonist, provides faster, greater, and more consistent adenosine diphosphate receptor inhibition, thus becoming an accepted option in several clinical situations, such as unstable angina, non-ST-segment elevation acute coronary syndrome, and percutaneous coronary intervention.…”

Section: Discussionmentioning

confidence: 99%

“…3 Moreover, an analysis of literature data showed several cases of druginduced anti-FVIII autoantibodies, highlighting this finding as one of the most relevant causes of AHA. 4 Recently, some cases of AHA associated with antiplatelet drug such as clopidogrel 5,6 and vitamin K antagonist, like warfarin, [7][8][9][10] have been reported. This makes the diagnosis of drug-associated autoantibodies against FVIII a complicated challenge, since the sudden onset of bleeding might be erroneously attributed to these drugs.…”

Section: Introductionmentioning

confidence: 99%

Acquired Hemophilia a may be Associated with Ticagrelor Therapy in a 52-Year-Old Man after a Recent Percutaneous Transluminal Coronary Angioplasty

Pasquino¹,

Canaparo

Capello³

et al. 2016

Clin Med Insights Case Rep

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We present a case report of a 52-year-old man who was hospitalized for right leg pain due to a relevant hemorrhagic effusion. He was on dual antiplatelet therapy (DAPT): acetylsalicylic acid and ticagrelor, a reversible P2Y12 receptor antagonist. Signs, symptoms, and laboratory blood tests led to the diagnosis of acquired hemophilia A (AHA). Ticagrelor therapy-associated AHA was hypothesized due to the fact that, before adding this drug, all laboratory and clinical examinations were repeatedly normal. Prednisone and cyclophosphamide treatment was started without DAPT interruption due to the high risk of stent thrombosis. After 10 days, prolonged activated partial thromboplastin time dropped from 107 to 49 seconds, the patient’s factor VIII (FVIII) levels gradually normalized over the following few weeks, and FVIII inhibitor titer was negative. Recently, some reports have established a link between the development of AHA and treatment with clopidogrel, an irreversible P2Y12 receptor antagonist. However, to the best of our knowledge, this is the first time that a link between AHA and ticagrelor has been reported.

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A patient with acquired hemophilia A induced by clopidogrel

Cited by 9 publications

References 14 publications

Acquired haemophilia and the New Oral Anticoagulants (NOACs): coincidence or drug‐induced adverse event?

Acquired haemophilia and the New Oral Anticoagulants (NOACs): coincidence or drug‐induced adverse event?

Acquired Factor V Inhibitor with Hemorrhagic Symptoms after Prasugrel Hydrochloride Treatment

Acquired Hemophilia a may be Associated with Ticagrelor Therapy in a 52-Year-Old Man after a Recent Percutaneous Transluminal Coronary Angioplasty

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