Do you ever use anticoagulation in patients with hemophilia?
James Douketis: It depends on the hemophilia. That is a very good question. As you know, hemophilia, depending on the type, is a spectrum. There are patients who have mild hemophilia who are not really at a high risk for bleeding and if they have, let’s say, a mechanical mitral valve, you probably want to have some measure of anticoagulation. You probably want to be careful in monitoring their hemophilia.
On the other hand, if they have a more severe form of a factor VIII or factor IX deficiency, it is a different situation. Fortunately, those cases are not very frequent, because they would be challenging. But hemophilia, or coagulation deficiency, factor XI deficiency, can be fairly benign and would not necessarily preclude the use of anticoagulants, if indicated.