Percutaneous Coronary Intervention in a Patient with Congenital Factor XI Deficiency and Acquired InhibitorMungee S. · Lapin R. · Cavusoglu E. · Clark L.T. · Marmur J.D.
Division of Cardiology, SUNY Downstate Medical Center, Brooklyn, N.Y., USA
Jonathan D. Marmur, MD
Director of Cardiac Catheterization and Interventional Cardiology
SUNY Health Science Center at Brooklyn, 450 Clarkson Avenue, Box 1257
Brooklyn, NY 11203-2098 (USA)
Tel. +1 718 270 3273, Fax +1 718 270 4503, E-Mail firstname.lastname@example.org
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Background: Factor XI deficiency has been associated with bleeding diathesis mostly secondary to trauma and post-operatively depending on the severity of deficiency. Cases with factor XI deficiency having undergone cardiac surgery and coronary intervention after appropriate replacement therapy have been reported in the past. The presence of inhibitor in factor XI deficiency poses a hematological challenge and literature regarding coronary intervention in such patients is limited. Immunosuppressive therapy, plasma exchange and factor VII product transfusions have been used prior to cardiac interventions in few such reported cases. Method: We report our approach in such a case of Percutaneous Transluminal Coronary Angioplasty in a 72-year-old male of Jewish origin who has congenital factor XI deficiency complicated with acquired inhibitor. Results: In some cases, the acuity of the coronary syndrome may mandate immediate coronary intervention. However, patient’s history of factor XI deficiency and acquired inhibitor pose a major dilemma of further course of action. We performed percutaneous balloon angioplasty in this case with no anti-coagulant and with favorable outcome. Conclusion: Under these circumstances of significant coagulation disorder and based on the case report, we recommend that balloon angioplasty be undertaken with no additional anti-coagulation other than Aspirin.
© 2007 S. Karger AG, Basel
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