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Ter-Zakarian A, Barnes RFW, Kruse-Jarres R, Quon DV, Jackson S, Sun HL, Drygalski AV. Blood pressure in persons with haemophilia with a focus on haemophilia-specific risk factors. Haemophilia 2022; 28:977-985. [PMID: 35768896 DOI: 10.1111/hae.14614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/26/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Persons with haemophilia (PWH) have a higher prevalence of hypertension compared to the general population, which cannot be explained entirely by the usual cardiovascular risk factors. Neutralizing antibodies (inhibitors) against clotting factors might have some relation to cardiovascular disease in PWH. However, whether inhibitors facilitate hypertension is unknown. AIM We investigated the relationship between hypertension/blood pressure and inhibitors in PWH. Additional goals were to determine the relationships with haemophilia type, race, and viral status. METHODS Records were extracted retrospectively for PWH (age ≥18 years) between 2003 and 2014 from four Hemophilia Treatment Centers in North America and included demographics, weight, height, haemophilia type/severity, HCV and HIV infection status, hypertension, use of anti-hypertensive medications, and inhibitor status. We fitted semiparametric generalized additive models (GAMs) to describe adjusted curves of blood pressure (BP) against age. RESULTS Among 691 PWH, 534 had haemophilia A and 157 had haemophilia B, with a median age of 39 years (range 18 to 79). Forty-four PWH (6.5%) had a history of inhibitors, without evidence for a higher prevalence of hypertension or higher BP. A higher prevalence of hypertension and higher BP were noted for haemophilia A (vs. haemophilia B), coinfection with HCV/HIV (vs. uninfected), or moderate haemophilia (vs. severe haemophilia). CONCLUSION While there was no signal to suggest that a history of inhibitors is associated with hypertension, differences based on haemophilia type, severity, and viral infection status were identified, encouraging prospective investigations to better delineate haemophilia-specific risk factors for hypertension.
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Affiliation(s)
- Anna Ter-Zakarian
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, California, USA
| | - Richard F W Barnes
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, California, USA
| | - Rebecca Kruse-Jarres
- Washington Center for Bleeding Disorders and University of Washington, Seattle, Washington, USA
| | - Doris V Quon
- Orthopaedic Hemophilia Treatment Center, Orthopaedic Institute for Children, Los Angeles, California, USA
| | - Shannon Jackson
- Department of Medicine, Division of Hematology, University of British Columbia, Vancouver, California, USA
| | - Haowei Linda Sun
- Department of Medicine, Division of Hematology, University of Alberta, Edmonton, California, USA
| | - Annette von Drygalski
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, California, USA
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2
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Camelo RM, Caram-Deelder C, Duarte BP, de Moura MCB, Costa NCDM, Costa IM, Roncal CGP, Vanderlei AM, Guimaraes TMR, Gouw S, Rezende SM, van der Bom J. Cardiovascular risk factors among adult patients with haemophilia. Int J Hematol 2021; 113:884-892. [PMID: 33677769 DOI: 10.1007/s12185-021-03104-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Abstract
Since the introduction of episodic and prophylactic treatments with safer factor concentrates, the life expectancy of people with haemophilia (PwH) has improved considerably. Ageing-related diseases such as cardiovascular disease (CVD) have also become more prevalent in PwH. This cross-sectional study aimed to evaluate CVD risk factors and estimate 10-year risk for CVD events among PwH. Male patients ≥ 30 years were interviewed and examined. Blood tests were performed at the local laboratory. Eighty-two patients were included, of whom 83% had haemophilia A and half had severe disease. Median age at study entry was 43.0 years (interquartile range [IQR], 36.0-51.3). Prevalence of obesity, systemic arterial hypertension (SAH) and diabetes mellitus were 16%, 60% and 16%, respectively. Hypertriglyceridaemia, hypercholesterolaemia and low HDL blood levels were present in 18%, 41% and 30% of patients, respectively. Metabolic syndrome was found in 37%. The Framingham Risk Score showed that 39% of PwH had a high risk of developing cardiovascular events in the following 10 years. We conclude that, in this cohort, PwH have a higher prevalence of SAH when compared with Brazilian men without haemophilia and about two-fifths have a high risk of developing a CVD event in the following 10 years.
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Affiliation(s)
- Ricardo Mesquita Camelo
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 2nd Floor, Room 255, Belo Horizonte, MG, 30130-100, Brazil. .,Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil. .,Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Camila Caram-Deelder
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.,Jon J Van Rood Centre for Clinical Transfusion Research, Sanquin/LUMC, Leiden, The Netherlands
| | - Bruna Pontes Duarte
- Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil
| | | | | | - Iris Maciel Costa
- Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil
| | | | - Ana Maria Vanderlei
- Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil
| | - Tania Maria Rocha Guimaraes
- Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil.,Faculdade de Enfermagem Nossa Senhora das Gracas, Universidade de Pernambuco, Recife, Brazil
| | - Samantha Gouw
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.,Paediatric Haematology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Suely Meireles Rezende
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 2nd Floor, Room 255, Belo Horizonte, MG, 30130-100, Brazil
| | - Johanna van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.,Jon J Van Rood Centre for Clinical Transfusion Research, Sanquin/LUMC, Leiden, The Netherlands
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3
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Zong Y, Maanja M, Chaireti R, Schlegel TT, Ugander M, Antovic JP. Substantial prevalence of subclinical cardiovascular diseases in patients with hemophilia A evaluated by advanced electrocardiography. J Electrocardiol 2020; 58:171-175. [DOI: 10.1016/j.jelectrocard.2019.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/05/2019] [Accepted: 12/11/2019] [Indexed: 12/11/2022]
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4
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A cross-sectional analysis of cardiovascular disease in the hemophilia population. Blood Adv 2019; 2:1325-1333. [PMID: 29895623 DOI: 10.1182/bloodadvances.2018018226] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/01/2018] [Indexed: 01/13/2023] Open
Abstract
Men with hemophilia were initially thought to be protected from cardiovascular disease (CVD), but it is now clear that atherothrombotic events occur. The primary objective of the CVD in Hemophilia study was to determine the prevalence of CVD and CVD risk factors in US older men with moderate and severe hemophilia and to compare findings with those reported in age-comparable men in the Atherosclerosis Risk in Communities (ARIC) cohort. We hypothesized if lower factor levels are protective from CVD, we would see a difference in CVD rates between more severely affected and unaffected men. Beginning in October 2012, 200 patients with moderate or severe hemophilia A or B (factor VIII or IX level ≤ 5%), aged 54 to 73 years, were enrolled at 19 US hemophilia treatment centers. Data were collected from patient interview and medical records. A fasting blood sample and electrocardiogram (ECG) were obtained and assayed and read centrally. CVD was defined as any angina, any myocardial infarction by ECG or physician diagnosis, any self-reported nonhemorrhagic stroke or transient ischemic attack verified by physicians, or any history of coronary bypass graft surgery or coronary artery angioplasty. CVD risk factors were common in the population. Compared with men of similar age in the ARIC cohort, patients with hemophilia had significantly less CVD (15% vs 25.8%; P < .001). However, on an individual patient level, CVD events occur and efforts to prevent cardiovascular events are warranted. Few men were receiving secondary prophylaxis with low-dose aspirin, despite published opinion that it can be used safely in this patient population.
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5
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Strauss E, Mazzeffi M, Williams B, Key N, Tanaka K. Perioperative management of rare coagulation factor deficiency states in cardiac surgery. Br J Anaesth 2017; 119:354-368. [DOI: 10.1093/bja/aex198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2017] [Indexed: 01/21/2023] Open
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Kahan S, Cuker A, Kushner RF, Maahs J, Recht M, Wadden T, Willis T, Majumdar S, Ungar D, Cooper D. Prevalence and impact of obesity in people with haemophilia: Review of literature and expert discussion around implementing weight management guidelines. Haemophilia 2017. [DOI: 10.1111/hae.13291] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- S. Kahan
- Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
| | - A. Cuker
- Perelman School of Medicine; University of Pennsylvania; Philadelphia PA USA
| | - R. F. Kushner
- Feinberg School of Medicine; Northwestern University; Chicago IL USA
| | - J. Maahs
- Indiana Hemophilia and Thrombosis Center; Indianapolis IN USA
| | - M. Recht
- Oregon Health & Science University; Portland OR USA
| | - T. Wadden
- Perelman School of Medicine; University of Pennsylvania; Philadelphia PA USA
| | - T. Willis
- Indiana Hemophilia and Thrombosis Center; Indianapolis IN USA
| | - S. Majumdar
- Division of Hematology; Children's National Medical Center; Washington DC USA
| | - D. Ungar
- Clinical, Medical, and Regulatory Affairs; Novo Nordisk Inc.; Plainsboro NJ USA
| | - D. Cooper
- Clinical, Medical, and Regulatory Affairs; Novo Nordisk Inc.; Plainsboro NJ USA
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7
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Miesbach W, Reitter-Pfoertner SE, Klamroth R, Langer F, Wolf HH, Tiede A, Siegmund B, Scholz U, Müller PR, Eichler H, Pabinger I. Co-morbidities and bleeding in elderly patients with haemophilia-A survey of the German, Austrian and Swiss Society of Thrombosis and Haemostasis Research (GTH). Haemophilia 2017. [DOI: 10.1111/hae.13296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- W. Miesbach
- Medical Clinic II; Institute of Transfusion Medicine; Goethe University; Frankfurt Germany
| | - S.-E. Reitter-Pfoertner
- Division of Haematology and Haemostaseology; Department of Medicine I; Medical University; Vienna Austria
| | - R. Klamroth
- Department of Angiology and Haemostaseology; Vivantes Clinic; Berlin Germany
| | - F. Langer
- II. Medical Clinic; University Clinic Eppendorf; Hamburg Germany
| | | | - A. Tiede
- Hannover Medical School; Hannover Germany
| | - B. Siegmund
- Institute for Thrombophilia and Haemaostaseology; Münster Germany
| | - U. Scholz
- Center of Haemostasis; MVZ Labor Leipzig; Germany
| | | | - H. Eichler
- Institute of Haemostaseology and Transfusion Medicine; University Hospital; Homburg/Saar Germany
| | - I. Pabinger
- Division of Haematology and Haemostaseology; Department of Medicine I; Medical University; Vienna Austria
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Barnes RFW, Cramer TJ, Hughes TH, von Drygalski A. The hypertension of hemophilia is associated with vascular remodeling in the joint. Microcirculation 2017. [PMID: 28627086 DOI: 10.1111/micc.12387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Hemophilic arthropathy is associated with pronounced vascular joint remodeling. Also, compared to the general population, PWH have a higher prevalence of hypertension not explained by usual risk factors. As vascular remodeling in various vascular beds is a hallmark of hypertension, we hypothesized that vascular joint remodeling is associated with elevated blood pressures and hypertension. METHODS Elbows, knees, and ankles of 28 adult PWH were evaluated for vascular abnormalities with MSKUS/PD, as well as for radiographic and clinical status and pain. Logistic and linear regression models were fitted to examine associations between hypertension, blood pressure, and PD score. RESULTS The extent of vascular abnormalities was associated with hypertension and blood pressures. Hypertensive patients had a higher PD score compared to nonhypertensive patients, and the risk of hypertension increased steeply with PD score. SBP was also strongly associated with PD score, while DBP was only weakly associated. CONCLUSIONS Vascular remodeling in hemophilic joints is associated with hypertension and elevated blood pressures. As hypertension is a grave risk factor for intracranial hemorrhage, a prominent cause of mortality in hemophilia patients, future studies are needed to address the causal pathways between vascular joint remodeling and blood pressure.
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Affiliation(s)
- Richard F W Barnes
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Thomas J Cramer
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Tudor H Hughes
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Annette von Drygalski
- Department of Medicine, University of California San Diego, San Diego, CA, USA.,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
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9
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The Hypertension of Hemophilia Is Not Explained by the Usual Cardiovascular Risk Factors: Results of a Cohort Study. Int J Hypertens 2016; 2016:2014201. [PMID: 27965893 PMCID: PMC5124662 DOI: 10.1155/2016/2014201] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/12/2016] [Indexed: 12/19/2022] Open
Abstract
Background. The etiology of the high prevalence of hypertension among patients with hemophilia (PWH) remains unknown. Methods. We compared 469 PWH in the United States with males from the National Health and Nutrition Examination Survey (NHANES) to determine whether differences in cardiovascular risk factors can account for the hypertension in hemophilia. Results. Median systolic and diastolic BP were higher in PWH than NHANES (P < 0.001) for subjects not taking antihypertensives. Those taking antihypertensives showed similar differences. Differences in both systolic and diastolic BP were especially marked among adults <30 years old. Differences between PWH and NHANES persisted after adjusting for age and risk factors (body mass index, renal function, cholesterol, smoking, diabetes, Hepatitis C, and race). Conclusions. Systolic and diastolic BP are higher in PWH than in the general male population and especially among PWH < 30 years old. The usual cardiovascular risk factors do not account for the etiology of the higher prevalence of hypertension in hemophilia. New investigations into the missing link between hemophilia and hypertension should include age of onset of hypertension and hemophilia-specific morbidities such as the role of inflammatory joint disease.
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10
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Berntorp E, Mauser-Bunschoten E, Jiménez-Yuste V, Spears JB. Comorbidities and inhibitors in adult patients with haemophilia: issues, costs and management strategies. Eur J Haematol 2016; 95 Suppl 80:1-15. [PMID: 26492487 DOI: 10.1111/ejh.12681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 01/19/2023]
Abstract
Along with greater life expectancy in patients with haemophilia has been an increase in associated haemophilia-related (arthropathy, osteoporosis, viral infections) and age-related (cardiovascular disease, renal disease, cancer and others) comorbidities, many of which are only just emerging as the population ages. At present, experience in managing these comorbidities is limited. As the demographic shift continues, haemophilia care centres can expect to encounter more patients with greater levels of complexity. In the absence of evidence-based information to guide the management of adult patients with haemophilia, it is important that the scientific position be reviewed on a regular basis. To this end, several topics relevant to the clinical management of adult patients with haemophilia were examined in a symposium entitled Comorbidities and inhibitors in adult patients with haemophilia: issues, costs and management strategies held on 11 February 2015 in Helsinki, Finland, in conjunction with the 8th Annual Congress of the European Association for Haemophilia and Allied Disorders. This article is a summary of that event.
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Affiliation(s)
- Erik Berntorp
- Clinical Coagulation Research Unit, Skåne University Hospital, Malmö, Sweden
| | - Evelien Mauser-Bunschoten
- Van Creveldkliniek, Department of Benign Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Víctor Jiménez-Yuste
- La Paz University Hospital, Coagulopathy Unit, Haematology Service, Madrid, Spain
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11
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Sousos N, Gavriilaki E, Vakalopoulou S, Garipidou V. Understanding cardiovascular risk in hemophilia: A step towards prevention and management. Thromb Res 2016; 140:14-21. [DOI: 10.1016/j.thromres.2016.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/31/2016] [Accepted: 02/01/2016] [Indexed: 01/03/2023]
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12
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Sun HL, Yang M, Sait AS, von Drygalski A, Jackson S. Haematuria is not a risk factor of hypertension or renal impairment in patients with haemophilia. Haemophilia 2016; 22:549-55. [DOI: 10.1111/hae.12921] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 11/30/2022]
Affiliation(s)
- H. L. Sun
- Division of Hematology; Department of Medicine; University of British Columbia; Vancouver BC Canada
- British Columbia Provincial Bleeding Disorders Program-Adult Division; Vancouver BC Canada
| | - M. Yang
- British Columbia Provincial Bleeding Disorders Program-Adult Division; Vancouver BC Canada
| | - A. S. Sait
- Department of Medicine; University of British Columbia; Vancouver BC Canada
| | - A. von Drygalski
- Division of Hematology/Oncology; Department of Medicine; University of California San Diego; San Diego CA USA
| | - S. Jackson
- Division of Hematology; Department of Medicine; University of British Columbia; Vancouver BC Canada
- British Columbia Provincial Bleeding Disorders Program-Adult Division; Vancouver BC Canada
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13
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Holme PA, Combescure C, Tait R, Berntorp E, Rauchensteiner S, de Moerloose P. Hypertension, haematuria and renal functioning in haemophilia - a cross-sectional study in Europe. Haemophilia 2015; 22:248-255. [DOI: 10.1111/hae.12847] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2015] [Indexed: 01/17/2023]
Affiliation(s)
- P. A. Holme
- Department of Haematology; Oslo University Hospital and Institute of Clinical Medicine University of Oslo; Oslo Norway
| | - C. Combescure
- University Hospital and Faculty of Medicine of Geneva; Geneva Switzerland
| | | | | | | | - P. de Moerloose
- University Hospital and Faculty of Medicine of Geneva; Geneva Switzerland
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14
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de Raucourt E, Roussel-Robert V, Zetterberg E. Prevention and treatment of atherosclerosis in haemophilia - how to balance risk of bleeding with risk of ischaemic events. Eur J Haematol 2015; 94 Suppl 77:23-9. [DOI: 10.1111/ejh.12498] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Emmanuelle de Raucourt
- HUPVNS, Hôpital Beaujon, Service d'Hematologie Biologique; Clichy and Centre d'Hémophilie Hopital Mignot; Le Chesnay France
| | | | - Eva Zetterberg
- Department of Hematology and Coagulation; Skåne University Hospital; Malmö Sweden
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