Table 1. Recommendations for management of acute coronary syndrome in patients with hemophilia.

Management	Recommendations
Initial management	Clotting factor correction aiming for a peak level of 80% for 48 hours with a trough level of 30% after 48 hours and as long as DAPT is given
Arterial access site	Radial access if possible to lower the risk of bleeding
Choice of stent	BMS if possible. May change soon given advances in DES
Antithrombotic therapy	UFH (bolus infusion 70 U/kg followed by continues infusion of 400 U/kg/day for 48 hours). May consider LMWH while keeping in mind the higher risk of bleeding
Antiplatelet therapy	Oral loading dose of 600 mg clopidogrel before percutaneous coronary intervention, followed by 75 mg clopidogrel daily for 4 weeks with trough clotting factor ≥30%

DAPT, dual antiplatelet therapy; BMS, bare-metal stent; DES, drug-eluting stent; UFH, unfractionated heparin; LMWH, low molecular weight heparin.