SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Myocardial Infarction is considered to be rare in hemophilic. This is one of sure unique cases and a review of the treatment recommended when sure situation occurs CASE PRESENTATION: 67-year-old male with severe hemophilia A complaint with his factor VIII (FVIII) regimen, presented with bleeding per rectum. He has no known risk factors for cardiovascular disease. He was started on FVIII infusion. On day two of admission, the patient complained of chest pain which was relieved with sublingual nitroglycerin. EKG showed T wave inversion in leads II, III and aVF, and Q waves in lead III. Initial troponin level was 1.79 ng/ml and peaked at 23 ng/ml. Echocardiogram showed inferior wall hypokinesis. Due to concern of the patient’s active GI bleed, anti-coagulation (AC) therapy were deferred. He was placed on sublingual nitroglycerin, morphine and oxygen therapy for symptomatic treatment. The patient was taken for colonoscopy with cauterization of the bleeding vessel. Dual anti-platelets therapy(DAPT) was subsequently started after resolution of the bleed and taken for a cardiac catheterization [ radial approach was use]which revealed a total occlusion of the RCA. A bare metal stent was placed. He was discharged on DAPT for 4 weeks and FVIII infusions. DISCUSSION: Patients with active bleed pose a challenge for health care providers as the risk vs benefits margins are narrower as compared to patient without bleeding. With a background of easy tendency to a major bleed in Hemophilia A, use of fibrinolytic therapy, antiplatelets, or anticoagulants is frightening and can be catastrophic. While the management of MIs is known to include AC, DAPT, and catheterization, these interventions may well be lethal in patients with active bleed. However, delays in treatment may result in permanent myocardial damage. Current recommendations include FVIII replacement to 100%, definitively treating the source of bleeding where possible prior to administration of DAPT and or AC. In regards to catheterization, the radial approach is preferred to the femoral approach to reduce the risk of bleeding while bare metal stents which are not traditionally the standard of management are preferred to drug eluting stent in these cases. This allows for a shorter duration of DAPT. A possible hypothesis is that MIs, in this group of patients, may result from inflammation due to repeated bleeding events. Hemophilia A and or FVIII infusion has not been reported as a predisposing factor for MI, but a few case reports have mentioned the development of MI in patient with FVIII infusion. CONCLUSIONS: We recommend management should be tailored to the individual patient presentation and carefully weighing the risks versus benefits of anticoagulation and anti- platelet therapy. Reference #1: Zupančić-Šalek, Silva MD, PhDa,b,c, Et al. A case report of acute inferior myocardial infarction in a patient with severe hemophilia A after recombinant factor VIII infusion. A case report December 2017 - Volume 96 - Issue 52 - p e9075 https://doi.org/10.1097/MD.0000000000009075 DISCLOSURES: No relevant relationships by Olere Esiemokhai, source=Web Response No relevant relationships by Christopher Nnaoma, source=Web Response No relevant relationships by Yee Tchao, source=Web Response