Hemophilia B with acute myocardial infarction is rare and presents a management challenge. Acute myocardial infarction demands restoration of blood flow to the jeopardised myocardium at the earliest. With a background of easy tendency to a major bleed in Hemophilia B, use of fibrinolytic therapy, antiplatelets, or anticoagulants are fraught with danger. A 52 year male with Hemophilia B, on regular maintainance doses of factor IX replacement, presented with acute anterior wall myocardial infarction. Patient had a history of oral bleed the previous day. His further management presented a challenge as fibrinolytic therapy or primary percutaneous intervention with stenting and subsequent use of antiplatelets and anticoagulants would invite the danger of life threatening major bleed. Patient had primary percutaneous coronary intervention under cover of one antiplatelet therapy and plain balloon angioplasty to culprit vessel was carried out with good outcomes.
Key words: Hemophilia B, Factor IX Defeciency, Acute Myocardial Infarction, Primary Percutaneous Intervention, Antiplatelets.