Hemophilia and Acute Myocardial Infarction: a Systematic Review

Abstract

Introduction: hemophilia is a coagulopathy where there is an absence or deficit of factors VIII or IX of the coagulation cascade, leading to high bleeding risk. In the past, people with hemophilia (PWH) had a markedly shorter life expectancy than the general population (GP). Over time, developments in pharmacotherapy and overall care have led to an increase in life expectancy. Given these, PWH could be at a higher risk of developing age-related diseases, such as acute myocardial infarction (AMI). Notably, the coagulation cascade plays an important role in the physiopathology of AMI. As such, there is interest in ascertaining if PWH could be at lower risk of AMI. Given this background, this study aimed to determine the prevalence of AMI in PWH, as compared to the GP, and the risk of mortality of AMI. Evidence acquisition: a search was performed on the Medline (PubMed), Scopus and ISI Web of Knowledge databases using the queries "hemophilia AND coronary artery disease", "hemophilia AND ischemic heart disease", "hemophilia AND myocardial infarction". Articles where the prevalence/mortality of AMI was described were included, whereas mechanistic and animal studies, and those with less than ten subjects were excluded. Evidence synthesis: eight articles reported a prevalence of AMI lower or without significant differences between in PWH and the GP. Three of the nine articles concerning mortality of AMI reported a lower mortality in PWH, and none reported a higher mortality. Conclusions: studies suggest that PWH have a lower prevalence (and mortality) of AMI than the GP.