JACC. Case reports · 2026
Acquired Hemophilia A During Prasugrel Therapy After Recurrent Acute Coronary Syndrome.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Yao Shumpei, Fujisawa Naoki, Otsuka Kenichiro, Nagasaki Joji, Kawase Takumi, Takahashi Yosuke, Fukuda Daiju
Аннотация
BACKGROUND: Acquired hemophilia A (AHA), a rare autoimmune bleeding disorder caused by factor VIII inhibitors, may be overlooked in patients receiving antiplatelet therapies.
CASE SUMMARY: A 60-year-old woman underwent percutaneous coronary intervention for non-ST-segment elevation myocardial infarction, receiving aspirin and prasugrel. After recurrent unstable angina, repeat percutaneous coronary intervention was performed, and dual antiplatelet therapy (DAPT) was resumed. One month later, she developed diffuse ecchymoses and progressive anemia. Investigations indicated AHA with isolated activated partial thromboplastin time (APTT) prolongation, reduced factor VIII activity, and factor VIII inhibitor positivity. DAPT was discontinued, and high-dose corticosteroid was initiated, causing complete remission; aspirin monotherapy was restarted. Unstable angina recurred, and coronary artery bypass grafting was performed.
DISCUSSION: Unexplained bleeding with isolated APTT prolongation on DAPT should prompt evaluation for AHA and early hematology consultation.
TAKE-HOME MESSAGE: Recognize AHA early; stop DAPT when safe, and favor revascularization strategies that minimize prolonged DAPT.
CASE SUMMARY: A 60-year-old woman underwent percutaneous coronary intervention for non-ST-segment elevation myocardial infarction, receiving aspirin and prasugrel. After recurrent unstable angina, repeat percutaneous coronary intervention was performed, and dual antiplatelet therapy (DAPT) was resumed. One month later, she developed diffuse ecchymoses and progressive anemia. Investigations indicated AHA with isolated activated partial thromboplastin time (APTT) prolongation, reduced factor VIII activity, and factor VIII inhibitor positivity. DAPT was discontinued, and high-dose corticosteroid was initiated, causing complete remission; aspirin monotherapy was restarted. Unstable angina recurred, and coronary artery bypass grafting was performed.
DISCUSSION: Unexplained bleeding with isolated APTT prolongation on DAPT should prompt evaluation for AHA and early hematology consultation.
TAKE-HOME MESSAGE: Recognize AHA early; stop DAPT when safe, and favor revascularization strategies that minimize prolonged DAPT.