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Hypercholesterolaemia - familial - Management
Additional information
Specialist treatments for people with homozygous FH
- Bile acid sequestrants (resins), nicotinic acid, and/or fibrates (usually in addition to statins and/or ezetimibe).
- Low-density lipoprotein (LDL) apheresis:
- Involves removal of blood (usually via an arterio-venous fistula) for treatment to clear low-density lipoprotein-cholesterol.
- Takes 3–4 hours and is required every 7–14 days.
- Should be considered for people with homozygous FH and, in exceptional circumstances, those with heterozygous FH.
- Angiotensin-converting enzyme (ACE) inhibitors are contraindicated and should be substituted with angiotensin-II receptor blockers.
- Warfarin should be discontinued 4 days prior to LDL apheresis and substituted with low molecular weight heparin.
- Liver transplant:
- May be considered for people with homozygous FH.
[Thompsen and Thompson, 2006; NICE, 2008]
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