Abstract

Pulmonary embolism (PE) is one of the major emergencies caused by the cardiovascular system, leading to substantial morbidity and mortality. The treatment of acute pulmonary embolism in patients with hemophilia is, on the other hand, a big challenge in the emergency department, requiring the conflicting demands of the need for anticoagulation therapy with the risks of bleeding due to the underlying condition of the patients. The conventional management of PE involves early anticoagulation, with the addition of thrombolytic therapy in the acute setting, but both are hazardous due to the tendency to bleed in these patients. This review aimed to describe the complex process of risk-benefit analysis, pointing out the value of personalized treatment and close hematologic surveillance. There are recent indications that short-term anticoagulation therapy, along with replacement of the clotting factors, can be effectively integrated from the monitor point of view, and with the direct oral anticoagulants showing favorable bleeding profiles compared with vitamin K antagonists. The importance of coordination between emergency, hematology, and other specialist departments was highlighted in the case reports, which played an important role in the successful management of these patients by achieving optimum outcomes. In conclusion, pulmonary embolism and hemophilia together represented a unique and challenging clinical situation, highlighting the necessity of precise management techniques and close multidisciplinary collaboration in the emergency room.

Key words: Management, acute pulmonary embolism, hemophilia, anticoagulation, bleeding risk, emergency room, review.