ACUTE POSTERIOR WALL MYOCARDIAL-INFARCTIO N AFTER ADMINISTRATION OF FACTOR-VIII CONCENTRATE TO A PATIENT WITH HEMOPHILIA-A

History and clinical finding: A 69-year-old man with severe haemophili a A sustained an acute myocardial infarction (MI) after self-administr ation of 3000 units factor VIII over 10 min, On admission he had no si gns of heart failure. Investigations: The ECC showed an acute posterio r wall MI. Creatinekinase rose to a maximum of 321 U/l with a signific ant MB proportion. The echocardiogram demonstrated hypokinesia of the posterior wall. Treatment and course: After initial thrombolysis treat ment with a total of 100 mg rtPA according to an accelerated scheme co ronary angiography, performed because the symptoms persisted, revealed two-vessel disease. A subtotal stenosis of the right coronary artery was balloon-dilated with good primary results. Regular factor VIII sub stitution was temporarily administered with the aim of initially achie ving high normal levels of factor VIII activity. Conclusion: Factor VI II substitution in haemophilia A may promote thrombotic complications, Thrombolytic treatment and balloon angioplasty of acute MI can be suc cessfully performed even in patients with severe haemophilia A.