1
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Tran DQ, Benson CC, Boice JA, Chitlur M, Dunn AL, Escobar MA, Gupta K, Johnsen JM, Jorgenson J, Martin SD, Martin S, Meeks SL, Narvaez AA, Quon DV, Reding MT, Reiss UM, Savage B, Schafer K, Steiner B, Thornburg C, Volland LM, von Drygalski A. Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: research priorities to transform the care of people with hemophilia. Expert Rev Hematol 2023; 16:19-37. [PMID: 36920859 PMCID: PMC10020869 DOI: 10.1080/17474086.2023.2171981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/19/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Decades of research have transformed hemophilia from severely limiting children's lives to a manageable disorder compatible with a full, active life, for many in high-income countries. The direction of future research will determine whether exciting developments truly advance health equity for all people with hemophilia (PWH). National Hemophilia Foundation (NHF) and American Thrombosis and Hemostasis Network conducted extensive inclusive all-stakeholder consultations to identify the priorities of people with inherited bleeding disorders and those who care for them. RESEARCH DESIGN AND METHODS Working group (WG) 1 of the NHF State of the Science Research Summit distilled the community-identified priorities for hemophilia A and B into concrete research questions and scored their feasibility, impact, and risk. RESULTS WG1 defined 63 top priority research questions concerning arthropathy/pain/bone health, inhibitors, diagnostics, gene therapy, the pediatric to adult transition of care, disparities faced by the community, and cardiovascular disease. This research has the potential to empower PWH to thrive despite lifelong comorbidities and achieve new standards of wellbeing, including psychosocial. CONCLUSIONS Collaborative research and care delivery will be key to capitalizing on current and horizon treatments and harnessing technical advances to improve diagnostics and testing, to advance health equity for all PWH.
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Affiliation(s)
- Duc Q. Tran
- Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University, Atlanta, Georgia, USA
| | - Craig C. Benson
- Sanofi ¬ Rare and Rare Blood Disorders Development, Cambridge, Massachusetts, USA
| | | | - Meera Chitlur
- Division of Hematology/Oncology, Central Michigan University College of Medicine, Detroit, Michigan, USA
| | - Amy L. Dunn
- Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Miguel A. Escobar
- Division of Hematology, UTHealth Houston McGovern Medical School, Gulf States Hemophilia and Thrombophilia Center, Houston, Texas, USA
| | - Kalpna Gupta
- Center for Bleeding and Clotting Disorders, Division Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, California, USA
| | - Jill M. Johnsen
- Bloodworks Northwest, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Washington Center for Bleeding Disorders, Seattle, Washington, USA
| | | | | | - Suzanne Martin
- Bleeding Disorders Association of South Carolina, Greenville, South Carolina, USA
| | - Shannon L. Meeks
- Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta Inc Aflac Cancer and Blood Disorders Center, Atlanta, Georgia, USA
| | - Alfredo A Narvaez
- Louisiana Center for Bleeding & Clotting Disorders, Tulane University, New Orleans, Louisiana, USA
| | - Doris V. Quon
- Orthopaedic Hemophilia Treatment Center, Orthopaedic Hospital of Los Angeles, California, USA
| | - Mark T. Reding
- Center for Bleeding and Clotting Disorders, Division Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ulrike M. Reiss
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Brittany Savage
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | - Kim Schafer
- Davis Hemostasis and Thrombosis Center, University of California Davis, Sacramento, California, USA
| | - Bruno Steiner
- Washington Center for Bleeding Disorders, Seattle, Washington, USA
| | - Courtney Thornburg
- Rady Children’s Hospital-San Diego, San Diego, California, USA
- UC San Diego, La Jolla, California, USA
| | | | - Annette von Drygalski
- Hemophilia & Thrombosis Treatment Center, University of California San Diego, California, USA
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2
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Schnohr C, Ekholm O, Poulsen LH, Lehrmann L, Andersen T, Funding E, Holm KB, Bjorner JB. Health and quality of life of patients with haemophilia: A national study of 124 Danish men. Haemophilia 2023; 29:538-544. [PMID: 36729615 DOI: 10.1111/hae.14751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE In the past decades, haemophilia treatment has greatly improved the health of persons with haemophilia (PWH). This study compares PWH to the general population on social conditions and health. METHODS In December 2021, all Danes with moderate or severe haemophilia A or B, or von Willebrands disease type 3 were invited to participate in an online self-report survey concerning sociodemographic factors, self-rated health, teeth status, chronic health conditions, symptoms and loneliness. This study compares responses from the 124 adult male PWH with responses from a male general population sample (N = 4849). Analyses used logistic regression, controlling for age and highest completed education. RESULTS Fewer PWH were in the oldest age group (65-84 years). Controlling for age, no significant differences were found regarding cohabitation status or education. Fewer PWH were employed (OR = .48, [.33-.71])-particularly in the 45-64 age group. PWH were less likely to report good health (OR = .49, [.31-.77]). The odds of joint disease was much higher (OR = 13.00, [8.37-20.28]). Also, hypertension (OR = 2.25, [1.13-5.65]) and previous stroke (OR = 2.51, [1.44-3.50]) were more frequent. PWH were more likely to report pain in the arms/hands/legs/hips (OR = 2.94, [1.92-4.52]), but less likely to report pain in the head/neck/shoulder (OR = .66, [.45-.96]). CONCLUSION The disease burden of haemophilia has improved so PWH resembles the general population in areas such as marriage and education. However, even for young PWH, the disease still imposes a significant burden from hemophilia arthropathy and pain in extremities and joints. Middle-aged PWH also have poorer levels of employment than same-aged peers.
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Affiliation(s)
- Christina Schnohr
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, Copenhagen, Denmark
| | | | | | | | - Eva Funding
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Jakob Bue Bjorner
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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3
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Shutov SA, Zozulya NI, Novikov VA, Shutova NA, Glebova AI, Kitsenko EA. [Surgery in patients with severe or inhibitory hemophilia A under prevention injection of emicizumab]. Khirurgiia (Mosk) 2023:72-83. [PMID: 37186654 DOI: 10.17116/hirurgia202305172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To determine the features of preoperative hemostatic therapy and laboratory control in patients with severe and inhibitory forms of hemophilia A under preventive treatment by FVIII. MATERIAL AND METHODS Four patients with severe and inhibitory forms of hemophilia A underwent surgery between 2021 and 2022. All patients received Emicizumab (the first monoclonal drug for «non-factor» therapy of hemophilia) for prevention of specific hemorrhagic signs of hemophilia. RESULTS Surgical intervention under preventive Emicizumab therapy was essential. Additional hemostatic therapy was not carried out or performed in reduced mode. There were no hemorrhagic, thrombotic or other complications. Thus, the so-called «non-factor» therapy is one of the variants for uncontrollable hemostasis in patients with severe and inhibitory forms of hemophilia. CONCLUSION Preventive injection of Emicizumab ensures certain buffer of hemostasis system and stable lower limit of coagulation potential. This is the result of stable concentration of Emicizumab when used in any of the registered forms regardless of age and other individual characteristics. The risk of acute severe hemorrhage is excluded, while the probability of thrombosis is not increased. Indeed, FVIII has higher affinity than Emicizumab and displaces Emicizumab from coagulation cascade that does not result summation of total coagulation potential.
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Affiliation(s)
- S A Shutov
- National Research Center for Hematology, Moscow, Russia
| | - N I Zozulya
- National Research Center for Hematology, Moscow, Russia
| | - V A Novikov
- National Research Center for Hematology, Moscow, Russia
| | - N A Shutova
- National Research Center for Hematology, Moscow, Russia
| | - A I Glebova
- National Research Center for Hematology, Moscow, Russia
| | - E A Kitsenko
- Petrovsky National Research Centre of Surgery, Moscow, Russia
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4
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Alam AU, Goodyear MD, Wu C, Sun HL. Increased acute care utilisation, comorbidities and mortality in adults with haemophilia: A population-based cohort study from 2012 to 2019. Haemophilia 2023; 29:219-229. [PMID: 36264207 DOI: 10.1111/hae.14680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Improvements in treatment strategies have led to increased life expectancy of persons with haemophilia (PWH). Consequently, age-related comorbidities become increasingly relevant. AIM To evaluate the prevalence of age-related comorbidities, mortality, health service utilisation and predictors of hospitalisation in PWH compared to the general population. METHODS We conducted a population-based retrospective cohort study using linked administrative data. Men with haemophilia were identified in Alberta, Canada (2012-2019) with a validated case definition and were age-matched with male population controls. We calculated the prevalence of major comorbidities, all-cause mortality, and examined health service utilisation including Emergency Department visits and hospitalisations. Logistic regression was applied to identify predictors of hospitalisation. RESULTS We identified 198 and 329 persons with moderately severe haemophilia and mild/moderate, respectively. Moderately severe haemophilia had a higher risk of death (standardised mortality ratio 3.2, 95% confidence interval [CI] 1.4-6.3) compared to the general population. PWH had a significantly higher prevalence of hypertension, liver diseases and malignancies than controls. Moderately severe haemophilia was associated with significantly higher rates of hospitalisations (52.5% vs. 14.5%), Emergency Department visits (89.1% vs. 62.7%) and intensive care admissions (8.9% vs. 2.3%). Age > 65 years (adjusted odds ratio [aOR] 6.8) and presence of multiple comorbidities (aOR 3.9) were significant predictors of hospitalisations among PWH. CONCLUSION Despite advanced care, haemophilia is associated with higher acute care utilisation than the general population, highlighting the substantial burden of illness on patients and the health care system.
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Affiliation(s)
- Arafat Ul Alam
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - M Dawn Goodyear
- Division of Hematology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Cynthia Wu
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Haowei Linda Sun
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, Canada
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5
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Reding MT, Pabinger I, Holme PA, Maas Enriquez M, Mancuso ME, Lalezari S, Miesbach W, Di Minno G, Klamroth R, Hermans C. Efficacy and safety of damoctocog alfa pegol prophylaxis in patients ⩾40 years with severe haemophilia A and comorbidities: post hoc analysis from the PROTECT VIII study. Ther Adv Hematol 2023; 14:20406207231166779. [PMID: 37113811 PMCID: PMC10126693 DOI: 10.1177/20406207231166779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/14/2023] [Indexed: 04/29/2023] Open
Abstract
Background Advances in treatment have enabled patients with haemophilia A to live longer and therefore may be subjected to comorbidities associated with ageing, in addition to disease-associated morbidities. There have been few reports to date on efficacy and safety of treatment specifically in patients with severe haemophilia A and comorbidities. Objective To explore the efficacy and safety of damoctocog alfa pegol prophylaxis in patients with severe haemophilia A aged ⩾40 years with comorbidities of interest. Design A post hoc analysis of data from the phase 2/3 PROTECT VIII study and its extension. Methods Bleeding and safety outcomes were analysed in a subgroup of patients aged ⩾40 years with ⩾1 comorbidity receiving damoctocog alfa pegol (BAY 94-9027; Jivi®) prophylaxis. Results Thirty-four patients with severe haemophilia A were included in this analysis, with a mean age of 49.4 years at time of enrolment. The most prevalent comorbidities were hepatitis C (n = 33; chronic, n = 23), hepatitis B (n = 8) and hypertension (n = 11). Four patients had human immunodeficiency virus. All received damoctocog alfa pegol prophylaxis for the entire study [median (range) time in study = 3.9 (1.0-6.9) years]. During the main study and extension, median total annualised bleeding rates (ABRs) (Q1; Q3) were 2.1 (0.0; 5.8) and 2.2 (0.6; 6.0), respectively; median joint ABRs were 1.9 (0.0; 4.4) and 1.6 (0.0; 4.0), respectively. Mean adherence with prophylaxis schedule was greater than 95% throughout the study. No deaths or thrombotic events were reported. Conclusion Efficacy, safety and adherence of damoctocog alfa pegol were confirmed in patients aged ⩾40 years with haemophilia A and one or more comorbidities, with data for up to 7 years supporting its use as a long-term treatment option in this group. Plain language summary Advances in treatment mean that people with haemophilia A are now living longer and, as a result, may have additional medical conditions that occur with ageing. We aimed to investigate the efficacy and safety of the long-acting replacement factor VIII damoctocog alfa pegol in people with severe haemophilia A who had additional medical conditions. To do this, we investigated the recorded information about patients aged 40 years of age or older who had been treated with damoctocog alfa pegol in a previously completed clinical trial. We found that the treatment was well-tolerated; no deaths or thrombotic events (undesirable clotting events) were reported. Treatment was efficacious in reducing bleeding in this group of patients. The findings support the use of damoctocog alfa pegol as a long-term treatment for older patients with haemophilia A and coexisting conditions.
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Affiliation(s)
| | - Ingrid Pabinger
- University Clinic for Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Pål Andrè Holme
- Department of Haematology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Milan, Italy; Humanitas University, Milan, Italy
| | - Shadan Lalezari
- National Haemophilia Centre, Chaim Sheba Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | | | - Giovanni Di Minno
- Department of Clinical and Experimental Medicine, University of Naples Federico II, Naples, Italy
| | | | - Cedric Hermans
- Division of Haematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Louvain, Belgium
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6
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Cardiovascular Risk Factors in Patients with Congenital Hemophilia: A Focus on Hypertension. Diagnostics (Basel) 2022; 12:diagnostics12122937. [PMID: 36552943 PMCID: PMC9776547 DOI: 10.3390/diagnostics12122937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022] Open
Abstract
Aging hemophiliacs face cardiovascular disease. Lots of evidence has been gathered that hemophiliacs have a more unfavorable cardiovascular profile than the general population does, especially due to the increased prevalence of hypertension (HTN). Among the existing scattered evidence, our study provides the most comprehensive and systematized analysis of the determinants of HTN in hemophiliacs. We discussed the contribution to the HTN substrate of hemophilia-specific factors, such as type, severity and the presence of inhibitors. The complex mechanism of kidney dysfunction in relation to hematuria and viral infections was meticulously addressed. Furthermore, we highlighted the new pathogenic concepts of endothelial dysfunction and the association between HTN and hemophilic arthropathy. The clustering of cardiovascular risk factors is common in hemophiliacs, and it enhances the negative vascular effect of HTN and aggravates HTN. It usually leads to an increased risk for coronary and cerebrovascular events. Our work provides reliable evidence to guide and improve the management of HTN in hemophiliacs.
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7
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Soucie JM, Le B, Dupervil B, Poston JN. Prevalence of comorbid conditions among older males with haemophilia receiving care in haemophilia treatment centers in the United States. Haemophilia 2022; 28:986-995. [PMID: 35924815 PMCID: PMC10591247 DOI: 10.1111/hae.14647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/08/2022] [Accepted: 07/17/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Increased survival among men with haemophilia has brought with it an increased risk of age-related comorbidities that may be challenging to treat in the presence of a bleeding disorder. AIM Estimate the prevalence of several age-related comorbidities among older males with haemophilia receiving care in the U.S. haemophilia treatment center (HTC) network compared to that among the general population. METHODS People with bleeding disorders who receive care in network HTCs can volunteer to participate in a surveillance registry that collects detailed clinical information including the presence of comorbid conditions at annual visits. We used registry data collected on males with haemophilia age 45 years and older to calculate lifetime prevalence of obesity, diabetes, hypertension, cardiovascular disease, renal disease, cancer, anxiety and depression. Comparable data on the U.S. general male population was obtained from the National Health Interview Survey. RESULTS During the surveillance period, 1592 middle-aged (45-64 years) and 645 older (≥65 years) patients with haemophilia had comorbidity data collected during 6435 HTC visits. Most haemophilia patients in both age groups had a higher prevalence of anxiety, depression and diabetes, but a lower prevalence of hypertension, coronary heart disease, stroke and myocardial infarction compared to the general U.S. male population. In addition, middle-aged patients had lower rates of leukemia, whereas older patients had higher rates of obesity than the general population. CONCLUSION These findings highlight the mental stress associated with this chronic condition and support continued public health obesity prevention efforts in the haemophilia community.
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Affiliation(s)
- J. Michael Soucie
- Division of Blood Disorders, Centers for Disease Control and Prevention,Atlanta, Georgia, USA
- Synergy America, Inc., Duluth, Georgia, USA
| | - Binh Le
- Division of Blood Disorders, Centers for Disease Control and Prevention,Atlanta, Georgia, USA
| | - Brandi Dupervil
- Division of Blood Disorders, Centers for Disease Control and Prevention,Atlanta, Georgia, USA
| | - Jacqueline N. Poston
- Division of Hematology and Oncology, Department of Medicine and Division of Clinical Pathology, Department of Pathology, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
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8
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Barnes RFW, Pandey B, Sun HL, Jackson S, Kruse-Jarres R, Quon DV, von Drygalski A. Diabetes, hepatitis C and human immunodeficiency virus influence hypertension risk differently in cohorts of haemophilia patients, veterans and the general population. Haemophilia 2022; 28:e228-e236. [PMID: 35877992 DOI: 10.1111/hae.14637] [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: 04/22/2022] [Revised: 06/16/2022] [Accepted: 07/09/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The reasons for the high prevalence of hypertension in persons with haemophilia (PWH) are poorly understood. AIM To examine the roles of diabetes, Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) in the etiology of hypertension for PWH. METHODS Retrospective cross-sectional design. Adult PWH (n = 691) were divided into two groups: (A) free of diabetes, HCV and HIV; (B) with diabetes and/or HCV positivity and/or HIV positivity. Each group was matched by race and age with random samples from the general population of the US (National Health and Nutrition Examination Surveys, NHANES) and outpatients at the Veterans Affairs Medical Center (VAMC) in San Diego. Generalized additive models (GAMs) were fitted for graphical analysis of hypertension risk over the lifespan. RESULTS In Group A, PWH had the highest prevalence of hypertension compared to NHANES and VAMC, especially in young adults. In Group B, diabetes increased the risk of hypertension for all three cohorts (PWH, NHANES and VAMC), especially for PWH. In PWH, hypertension risk was also increased by HIV, in NHANES by HCV, and in VAMC by HCV and HIV. CONCLUSION Diabetes conferred the greatest risk of hypertension for all three cohorts. However, curves of hypertension in relation to age revealed that diabetes, HCV and HIV modulated hypertension risk differently in PWH. PWH experienced a disproportionally high risk increase with diabetes. Therefore, haemophilia care should include screening for hypertension and diabetes at a young age.
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Affiliation(s)
- Richard F W Barnes
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Braj Pandey
- Department of Medicine, University of California San Diego, San Diego, California, USA.,Department of Primary Care, Veterans Affairs Medical Center, San Diego, California, USA
| | | | | | - Rebecca Kruse-Jarres
- Washington Center for Bleeding Disorders at Bloodworks Northwest, Seattle, Washington, USA
| | - Doris V Quon
- Orthopaedic Institute for Children, Los Angeles, California, USA
| | - Annette von Drygalski
- Department of Medicine, University of California San Diego, San Diego, California, USA
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9
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van Bergen E, Monnikhof M, Lafeber F, Schutgens R, Mastbergen S, van Vulpen L. The fear for adverse bleeding and cardiovascular events in hemophilia patients using (non-)selective non-steroidal anti-inflammatory drugs: A systematic review reporting on safety. Blood Rev 2022; 56:100987. [DOI: 10.1016/j.blre.2022.100987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/02/2022]
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10
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Tomschi F, Ransmann P, Hilberg T. Aerobic exercise in patients with haemophilia: A systematic review on safety, feasibility and health effects. Haemophilia 2022; 28:397-408. [PMID: 35226779 DOI: 10.1111/hae.14522] [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: 12/03/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Haemophilia is a congenital bleeding disorder going along with disease-specific joint complications and general health implications attributed to the lack of daily movement. Recent guidelines recommend physical activity for people with haemophilia (PwH). Yet, aerobic exercise in PwH is little studied and seldomly prescribed by clinicans. AIM The aim of this systematic review is to investigate the safety, feasibility and health-related efficiency of AE in PwH. METHODS A systematic literature search according to the PRISMA guidelines was conducted (PubMed, Web of Science). Inclusion criteria were defined using PICOS. Methodological quality was assessed via TESTEX. RESULTS Out of 789 studies identified, seven studies (three randomized controlled, two controlled, two single-group prospective trails) were included. The TESTEX mean score was 8.1 (±3.8). AE was realized as aquatic exercise, nordic walking, treadmill running, bicycle riding and swimming. Neither bleeding rates nor the factor amount increased and AE led to diverse health-related improvements. CONCLUSIONS Little research has been conducted evaluating AE in PwH. Yet, AE can be considered as safe and feasible when being supervised by experts. However, disease-specific recommendations for AE are difficult to provide. Therefore, experts can currently only back AE recommendations on experience and nonhaemophilia-specific general guidelines.
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Affiliation(s)
- Fabian Tomschi
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Pia Ransmann
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
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11
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Shapiro S, Benson G, Evans G, Harrison C, Mangles S, Makris M. Cardiovascular disease in hereditary haemophilia: The challenges of longevity. Br J Haematol 2022; 197:397-406. [PMID: 35191019 PMCID: PMC9306870 DOI: 10.1111/bjh.18085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022]
Abstract
The development of effective and safe treatments has significantly increased the life expectancy of persons with haemophilia (PWH). This has been accompanied by an increase in the comorbidities of ageing including cardiovascular disease, which poses particular challenges due to the opposing risks of bleeding from haemophilia and antithrombotic treatments versus thrombosis. Although mortality secondary to coronary artery disease in PWH is less than in the general population, the rate of atherosclerosis appears similar. The prevalence of atrial fibrillation in PWH and risk of secondary thromboembolic stroke are not well established. PWH can be safely supported through acute coronary interventions but data on the safety and efficacy of long‐term antithrombotics are scarce. Increased awareness and research on cardiovascular disease in PWH will be crucial to improve primary prevention, acute management, secondary prevention and to best support ageing PWH.
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Affiliation(s)
- Susan Shapiro
- Oxford University Hospitals NHS Foundation Trust, Oxford NIHR Biomedical Research Centre, Oxford, UK.,Radcliffe Department of Medicine, Oxford University, Oxford, UK
| | | | - Gillian Evans
- Kent Haemophilia and Thrombosis Centre, East Kent Hospitals University Foundation NHS Trust, Canterbury, UK
| | - Catherine Harrison
- Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sarah Mangles
- Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Mike Makris
- Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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12
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Kennedy M, O'Gorman P, Monaghan A, Lavin M, O'Mahony B, O'Connell NM, O' Donnell JS, Turecek PL, Gormley J. A systematic review of physical activity in people with haemophilia and its relationship with bleeding phenotype and treatment regimen. Haemophilia 2021; 27:544-562. [PMID: 33751742 PMCID: PMC8359343 DOI: 10.1111/hae.14282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Although the measurement of physical activity (PA) amongst people with haemophilia (PWH) has become increasingly widespread in recent years, the relationship between PA and bleeding phenotype remains poorly understood. In addition, the influence of various treatment regimens on this relationship has not been defined. AIM This review aimed to systematically assess the data that are available regarding PA levels amongst PWH, as well as the relationship between PA and bleeding. METHODS A systematic search of the online databases EMBASE, Cochrane, MEDLINE Ovid, CINAHL and Web of Science was conducted by two independent reviewers. Quality assessment was undertaken using the AXIS Critical Appraisal Tool for Cross-sectional Studies and the STROBE checklist. RESULTS Of 1902 sources identified overall, 36 articles were included. Low-to-moderate transparency of reporting and various sources of bias were identified. PA levels varied amongst heterogeneous samples of PWH. The relationship between PA and bleeds was inconclusive, although there was evidence that improvements in treatment over recent decades have appeared to enable PWH to become more physically active. CONCLUSION Based upon the limited available evidence, the relationship between PA and bleeding phenotype in PWH remains unclear. However, with the development of improved prophylaxis treatment regimens in recent years, there is evidence that PA levels have increased, especially amongst people with severe haemophilia. The use of validated outcome measures of PA and more robust reporting of bleeds and treatment regimen are warranted in future research, especially in a rapidly evolving era of new treatments for PWH.
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Affiliation(s)
- Megan Kennedy
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | - Philip O'Gorman
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | - Ann Monaghan
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | - Michelle Lavin
- National Coagulation Centre, St. James's Hospital, Dublin 8, Ireland.,Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Niamh M O'Connell
- National Coagulation Centre, St. James's Hospital, Dublin 8, Ireland
| | - James S O' Donnell
- National Coagulation Centre, St. James's Hospital, Dublin 8, Ireland.,Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Peter L Turecek
- Baxalta Innovations GmbH, A Member of the Takeda Group of Companies, Vienna, Austria
| | - John Gormley
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
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13
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Coppola A, Tagliaferri A, Rivolta GF, Quintavalle G, Franchini M. Confronting COVID-19: Issues in Hemophilia and Congenital Bleeding Disorders. Semin Thromb Hemost 2020; 46:819-822. [PMID: 32512586 PMCID: PMC7645823 DOI: 10.1055/s-0040-1712961] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Antonio Coppola
- Regional Reference Center for Inherited Bleeding Disorders University, Hospital of Parma, Parma, Italy
| | - Annarita Tagliaferri
- Regional Reference Center for Inherited Bleeding Disorders University, Hospital of Parma, Parma, Italy
| | - Gianna Franca Rivolta
- Regional Reference Center for Inherited Bleeding Disorders University, Hospital of Parma, Parma, Italy
| | - Gabriele Quintavalle
- Regional Reference Center for Inherited Bleeding Disorders University, Hospital of Parma, Parma, Italy
| | - Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
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14
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Özdemir ZC, Köşger P, Uçar B, Bör Ö. Myocardial functions, blood pressure changes, and arterial stiffness in children with severe hemophilia A. Thromb Res 2020; 189:102-107. [PMID: 32197138 DOI: 10.1016/j.thromres.2020.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/17/2020] [Accepted: 03/05/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Prolonging the life span of patients with hemophilia has led to the emergence of comorbidities. Cardiovascular diseases are one of the important causes of mortality in patients with hemophilia. This study investigated the myocardial functions, blood pressure changes, arterial stiffness, and risk factors associated with cardiovascular diseases in children with hemophilia. MATERIAL AND METHODS In total, 17 children with severe hemophilia A and 23 healthy children were included in the study. Myocardial functions were evaluated using standard and tissue Doppler echocardiography. Peripheral and central blood pressure measurements were performed, and arterial stiffness was evaluated. Carotid intima-media thicknesses (CIMT) serum glucose, insulin, insulin resistance index, and lipoprotein levels were measured. RESULTS There were no differences between the two groups in terms of age, and biochemical parameters (P > 0.05). The HDL-C levels in the hemophilia group were lower than those in the control group (P < 0.05). Five of the patients had insulin resistance (29.4%), whereas four had low HDL-C levels (23.5%). There were no differences between the groups in terms of the CIMT, peripheral blood pressure, and central systolic blood pressure (P > 0.05). In the hemophilia group, central diastolic blood pressure (cDBP), arterial stiffness, and myocardial performance index were higher (P < 0.05, P = 0.01, P < 0.01), whereas the ejection time was shorter than in the control group (P < 0.05). CONCLUSIONS Compared with the control group, there is an onset of arterial stiffness, cDBP values tend to increase, and serum HDL-C levels are lower in the hemophilia group. Moreover, myocardial systolic functions demonstrate a deterioration that becomes more prominent with the increase in arterial stiffness.
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Affiliation(s)
- Zeynep Canan Özdemir
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Eskişehir Osmangazi University, Faculty of Medicine, 26480 Eskişehir, Turkey.
| | - Pelin Köşger
- Division of Pediatric Cardiology, Department of Pediatrics, Eskişehir Osmangazi University, Faculty of Medicine, 26480 Eskişehir, Turkey
| | - Birsen Uçar
- Division of Pediatric Cardiology, Department of Pediatrics, Eskişehir Osmangazi University, Faculty of Medicine, 26480 Eskişehir, Turkey
| | - Özcan Bör
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Eskişehir Osmangazi University, Faculty of Medicine, 26480 Eskişehir, Turkey.
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15
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Qvigstad C, Tait RC, de Moerloose P, Holme PA. Hematuria in aging men with hemophilia: Association with factor prophylaxis. Res Pract Thromb Haemost 2020; 4:309-317. [PMID: 32110762 PMCID: PMC7040553 DOI: 10.1002/rth2.12298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/17/2019] [Accepted: 11/22/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Macroscopic hematuria is considered a significant risk factor for urologic disease, and it is highly prevalent in people with hemophilia. AIM To determine whether prophylactic factor replacement therapy is associated with reduced occurrence of macroscopic hematuria in people with hemophilia in a post hoc analysis using data from a cross-sectional study conducted by the Age-Related Developments and Comobordities in Hemophilia (ADVANCE) Working Group that included males with hemophilia ≥40 years of age. METHODS Data from 16 contributing centers, in 13 European countries and Israel, were analyzed using logistic regression. Of 532 recruited individuals, this analysis included 370 patients with moderate or severe hemophilia who received on-demand or prophylactic therapy. RESULTS For patients with a history of macroscopic hematuria, we analyzed the association between prophylaxis and reoccurrence of macroscopic hematuria within the past 5 years (n = 235 patients). Frequent (≥3 times/wk) prophylaxis was negatively associated with a recent episode of macroscopic hematuria (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.18-0.76). We also analyzed whether prophylaxis corresponded to a lower lifetime number of macroscopic hematuria episodes (n = 285 patients). Frequent prophylaxis for >15 years was associated with a lower number of episodes compared to on-demand treatment (OR, 0.29; 95% CI, 0.16-0.54), whereas nonsteroidal anti-inflammatory drugs (NSAIDs) and severe hemophilia were associated with a higher number. There was no association of prophylaxis <3 times/wk with hematuria. CONCLUSION Frequent prophylaxis was negatively associated with the number of episodes of macroscopic hematuria in people with hemophilia. Prevalence of macroscopic hematuria was higher among individuals with severe hemophilia and those regularly using NSAIDs.
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Affiliation(s)
- Christian Qvigstad
- Department of HaematologyOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | | | | | - Pål Andre Holme
- Department of HaematologyOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
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16
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Qvigstad C, Sørensen LQ, Tait RC, de Moerloose P, Holme PA. Macroscopic hematuria as a risk factor for hypertension in ageing people with hemophilia and a family history of hypertension. Medicine (Baltimore) 2020; 99:e19339. [PMID: 32118768 PMCID: PMC7478422 DOI: 10.1097/md.0000000000019339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Ageing people with hemophilia (PWH) have a higher prevalence of hypertension than the general population. This study aimed to determine whether macroscopic hematuria was associated with hypertension in PWH in a post hoc analysis using data from a cross-sectional study conducted by the ADVANCE Working Group (the H3 study), which included PWH ≥ 40 years of age. Data from 16 contributing centers, located in 13 European countries and Israel, were analyzed using logistic regression models. Of 532 recruited PWH in the H3 study, 117 had hypertension and a positive family history of hypertension (hypertension FH+), 75 had hypertension and a negative family history of hypertension (hypertension FH-), 290 had no diagnosis of hypertension, and the remaining 50 had missing hypertension data. Logistic regressions showed that macroscopic hematuria was associated with hypertension FH+, both in the univariate (OR = 1.84 [1.17-2.90], P = .01) and in the multivariate model (OR = 1.80 [1.03-3.16], P = .04). Macroscopic hematuria was not associated with hypertension FH-. Moreover, in a multivariate logistic regression the odds of hypertension FH+ were increased with the number of macroscopic hematuria episodes. The association between macroscopic hematuria and hypertension was significant for PWH with a family history of hypertension.
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Affiliation(s)
- Christian Qvigstad
- Department of Haematology Oslo University Hospital
- Institute of Clinical Medicine University of Oslo
| | | | | | | | - Pål Andre Holme
- Department of Haematology Oslo University Hospital
- Institute of Clinical Medicine University of Oslo
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17
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Akhmimi A, Lip GYH, Shantsila A. What is the impact of the latest ACC/AHA and ESC/ESH guidelines on the management of hypertension in the UK? Expert Opin Pharmacother 2020; 21:1123-1125. [PMID: 31899988 DOI: 10.1080/14656566.2019.1707183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Azhar Akhmimi
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital , Liverpool, UK.,Echo-Cardiovascular Technology Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences , Riyadh, Saudi Arabia
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital , Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University , Aalborg, Denmark
| | - Alena Shantsila
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital , Liverpool, UK
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18
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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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19
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Lövdahl S, Henriksson KM, Baghaei F, Holmström M, Berntorp E, Astermark J. Hypertension and cardiovascular diseases in Swedish persons with haemophilia — A longitudinal registry study. Thromb Res 2019; 181:106-111. [DOI: 10.1016/j.thromres.2019.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/25/2019] [Accepted: 07/19/2019] [Indexed: 11/28/2022]
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20
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Davis KA, Stanek JR, Dunn AL. Screening urinalysis demonstrates that haematuria is a frequent finding in persons with haemophilia treated at a paediatric haemophilia treatment centre. Haemophilia 2019; 25:782-788. [PMID: 31291048 DOI: 10.1111/hae.13815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/03/2019] [Accepted: 06/14/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Haematuria is a recognized complication of haemophilia A and B (HA, HB). Adult persons with haemophilia (PWH) have a higher prevalence of renal disease than the general population. There is limited literature investigating the prevalence of haematuria in paediatric PWH. AIM Our paediatric haemophilia treatment centre (HTC) had previously used quality improvement methods to increase the frequency of screening urinalyses at annual comprehensive visits. We retrospectively reviewed the data collected to determine the prevalence of haematuria and explore for associations in those with haematuria. METHODS Retrospective chart review to identify the frequency of haematuria on screening urinalysis in all male PWH ≥2 years old. Haematuria was defined as ≥3 red blood cells (RBCs) per high power field. Univariate logistic regression was performed to evaluate for associations with haematuria. RESULTS A total of 93 patients met eligibility criteria. Sixty-seven with HA (11 mild, 17 moderate, 39 severe) and 26 with HB (three mild, 16 moderate, seven severe). Forty-two of ninety-three (45%) patients were identified as having haematuria (median RBCs 7, mean RBCs 332). Of those with haematuria, 76% were identified by screening UA, as opposed to clinical symptoms, and 52% had recurrent haematuria. Older age and HA were associated with an increased likelihood of haematuria. CONCLUSIONS Our study demonstrated that the prevalence of haematuria was high in PWH treated at our paediatric HTC. Future investigation is needed to determine the population-wide prevalence of haematuria in paediatric PWH and its impact on renal function.
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Affiliation(s)
| | | | - Amy L Dunn
- Nationwide Children's Hospital, Columbus, Ohio
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21
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Parhampour B, Dadgoo M, Vasaghi-Gharamaleki B, Torkaman G, Ravanbod R, Mirzaii-Dizgah I, Reza Baghaipour M, Saneii SH. The effects of six-week resistance, aerobic and combined exercises on the pro-inflammatory and anti-inflammatory markers in overweight patients with moderate haemophilia A: A randomized controlled trial. Haemophilia 2019; 25:e257-e266. [PMID: 31131517 DOI: 10.1111/hae.13764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/29/2019] [Accepted: 03/30/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Overweight increases the secretion of pro-inflammatory cytokines and serves as a major risk factor for arthropathy and cardiovascular diseases (CVD). This condition is becoming increasingly prevalent among patients with haemophilia (PWH). Different forms of exercise training could favourably modify weight-related complications, cardiovascular risk factors and the inflammation. AIM To investigate the effects of resistance, aerobic and combined exercises on the pro-inflammatory and anti-inflammatory markers in overweight patients with moderate haemophilia A. METHODS Forty-eight patients with moderate haemophilia A, aged 35-55 years, and body mass index (BMI) of 25-30 kg/m2 were randomly assigned to resistance training (RT, n = 12), aerobic (AT, n = 12), combined training (CT, n = 12) and control (n = 12) groups. The patients participated in 45-minutes exercise sessions three times a week for 6 weeks. Waist circumference (WC), waist-to-hip ratio (WHR), fat mass, fat-free mass, interleukin-10 (IL-10), adiponectin, tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6) and high sensitive C-reactive protein (hs-CRP) were measured before and after the 6 weeks of training. RESULTS There was significant decrease in WC, WHR, BMI and weight in the AT, RT and CT groups as compared to the control group. Total HJHS scores decreased in the AT, RT, CT groups compared to the control groups (P ≤ 0.001). The decrease in hs-CRP, IL-6 and TNF-α in the CT group was significant compared to the control group (P ≤ 0.02). The increase in IL-10 and adiponectin was not significant in the RT, AT and CT groups compared to the control group. CONCLUSION CT was the most effective training mode for decreasing the pro-inflammatory cytokines and increasing anti-inflammatory markers in overweight patients with haemophilia A.
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Affiliation(s)
- Behrouz Parhampour
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Dadgoo
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Behnoosh Vasaghi-Gharamaleki
- Rehabilitation Research Center, Department of Rehabilitation Basic Sciences, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Giti Torkaman
- Department of Physical Therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Roya Ravanbod
- Department of Physical Therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Iraj Mirzaii-Dizgah
- Department of physiology, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | | | - Seyed Hassan Saneii
- Rehabilitation Research Center, Department of Rehabilitation Basic Sciences, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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22
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Nagao A, Suzuki N, Takedani H, Yamasaki N, Chikasawa Y, Sawada A, Kanematsu T, Nojima M, Higasa S, Amano K, Fukutake K, Fujii T, Matsushita T, Suzuki T. Ischaemic events are rare, and the prevalence of hypertension is not high in Japanese adults with haemophilia: First multicentre study in Asia. Haemophilia 2019; 25:e223-e230. [DOI: 10.1111/hae.13749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/25/2019] [Accepted: 03/13/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Azusa Nagao
- Department of Blood Coagulation Ogikubo Hospital Tokyo Japan
| | - Nobuaki Suzuki
- Department of Transfusion Medicine Nagoya University Hospital Aichi Japan
| | - Hideyuki Takedani
- Department of Joint Surgery IMSUT Hospital, The Institute of Medical Science, The University of Tokyo Tokyo Japan
| | - Naoya Yamasaki
- Division of Blood Transfusion Hiroshima University hospital Hiroshima Japan
| | - Yushi Chikasawa
- Department of Laboratory Medicine Tokyo Medical University Tokyo Japan
| | - Akihiro Sawada
- Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Hyogo Japan
| | - Takeshi Kanematsu
- Department of Clinical Laboratory Nagoya University Hospital Aichi Japan
| | - Masanori Nojima
- Center for Translational Research The Institute of Medical Science Hospital, The University of Tokyo Tokyo Japan
| | - Satoshi Higasa
- Division of Hematology, Department of Internal Medicine Hyogo College of Medicine Hyogo Japan
| | - Kagehiro Amano
- Department of Laboratory Medicine Tokyo Medical University Tokyo Japan
- Department of Molecular Genetics of Coagulation Disorders Tokyo Medical University Tokyo Japan
| | - Katsuyuki Fukutake
- Department of Laboratory Medicine Tokyo Medical University Tokyo Japan
- Department of Molecular Genetics of Coagulation Disorders Tokyo Medical University Tokyo Japan
| | - Teruhisa Fujii
- Division of Blood Transfusion Hiroshima University hospital Hiroshima Japan
| | - Tadashi Matsushita
- Department of Transfusion Medicine Nagoya University Hospital Aichi Japan
| | - Takashi Suzuki
- Department of Blood Coagulation Ogikubo Hospital Tokyo Japan
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23
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Factor VIII: Long-established role in haemophilia A and emerging evidence beyond haemostasis. Blood Rev 2019; 35:43-50. [DOI: 10.1016/j.blre.2019.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/01/2019] [Accepted: 03/01/2019] [Indexed: 12/20/2022]
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24
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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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25
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[Clinical management of patients with hemophilia A in nephrology: Diagnostic and therapeutic challenges illustrated by the cases of 2 patients]. Nephrol Ther 2019; 15:77-81. [PMID: 30660587 DOI: 10.1016/j.nephro.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/14/2018] [Accepted: 10/25/2018] [Indexed: 11/22/2022]
Abstract
Hemophilia A is an X-linked genetic hemorrhagic disorder characterized by a factor VIII deficiency. The availability of secured substitution products has led to a dramatic improvement of life expectancy in hemophiliac patients. Nowadays, adult hemophiliac patients may develop Chronic Kidney Disease (CKD) resulting from age-related comorbidities (hypertension, obesity, diabetes). In addition, the high prevalence of viral infections in this population exposes patients to an increased risk of CKD. The risk of hemorrhage in hemophiliac patients is a challenge for their clinical management, both for diagnostic procedures (kidney biopsy in particular) and for renal replacement therapy (dialysis or renal transplantation) when it is needed. This work provides an update of the literature data concerning the management of hemophiliac patients in nephrology, illustrated by the cases of two patients.
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Abstract
Advances in the development of effective and safe treatments for haemophilia over the last 50 years have resulted in a significant increase in the life expectancy of persons with haemophilia (PWH). The management of this new cohort of middle-aged and elderly PWH is challenging because of the opposing risks of haemophilia and age-related cardiovascular disease and malignancy. Furthermore, this cohort of ageing PWH has the additional comorbidities of human immunodeficiency virus/hepatitis C and chronic haemophilic arthropathy. This article reviews the prevalence, underlying mechanisms and treatment strategies for managing these comorbidities. International collaboration is essential for registry data and further prospective trials to inform optimal evidence-based management for this rare disorder in the future.
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Affiliation(s)
- Susan Shapiro
- Oxford Haemophilia and Thrombosis Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mike Makris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, UK
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27
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Limjoco J, Thornburg CD. Risk factors for cardiovascular disease in children and young adults with haemophilia. Haemophilia 2018; 24:747-754. [PMID: 30004151 PMCID: PMC6153073 DOI: 10.1111/hae.13585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The origins of cardiovascular disease (CVD) begin in childhood. The primary objective of this cross-sectional cohort study was to determine the prevalence of cardiovascular risk factors in patients with congenital haemophilia A or B followed at Rady Children's Hospital San Diego Hemophilia and Thrombosis Treatment Center (HTC). We hypothesized that cardiovascular risk factors could be identified as part of a comprehensive clinic visit. MATERIALS AND METHODS Standardized measurement of weight, height, waist circumference and blood pressure plus non-fasting glucose and lipid panel were performed. Participants and/or caregivers completed questionnaires about family history, medical history and lifestyle. Clinical data were abstracted from the medical record. Descriptive statistics, Student's t test, correlation, Mann-Whitney U test and chi-square test were performed to analyse the data. RESULTS Forty-three males (mean 12 years, range 5-20 years) enrolled. High rates of overweight and obesity, (pre)hypertension and abnormal lipids were identified. Subjects with normal weight had more days of >60 minutes of physical activity compared with those with overweight or obesity (5.2 ± 2.4 vs. 3.8 ± 2.5 day; P = 0.07). Higher weight was correlated with higher factor consumption (cor = 0.88; P < 0.001). There was no difference in target joints based on weight category (30% in normal weight vs. 25% in overweight or obese, χ2 = 0.11, P = 0.74), which may be attributed to high rates of prophylaxis. CONCLUSIONS Modifiable risk factors for CVD were identified as part of the study during comprehensive clinic visits. The HTC team may develop behavioural interventions to target cardiovascular risk reduction as part of the comprehensive care model.
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28
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Prevalence of Hypertension (HTN) and Cardiovascular Risk Factors in a Hospitalized Pediatric Hemophilia Population. J Pediatr Hematol Oncol 2018; 40:196-199. [PMID: 29240038 DOI: 10.1097/mph.0000000000001036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Improved life expectancy in hemophilia has led to a greater interest in age-related disorders. Hypertension (HTN) as well as cardiovascular disease have been increasingly reported in hemophilic adults but there is currently very limited data in the pediatric population. We conducted a cross-sectional study using data from the 2012 National Health Cost and Utilization Project database to determine the prevalence of HTN and associated cardiovascular risk factors in a hospitalized pediatric hemophilia population, between the ages of 0 to 21 years, in comparison with the general pediatric population. The prevalence of HTN was significantly higher in children with hemophilia (CWH) in comparison with the general pediatric population (1.71% vs. 1.02%, P-value=0.005). When adjusting the analysis for sex, the prevalence of HTN in the hemophilia cohort remained higher, although not statistically significant (1.52% vs. 1.22%, P-value=0.2568). When examining the concomitant presence of ≥1 cardiovascular risk factors in the hypertensive subgroups, CWH had a higher prevalence of obesity (2.64% vs. 1.32%, P-value <0.0001). Interestingly, diabetes mellitus was more prevalent in nonhemophilic children (1.47% vs. 0.56%, P-value=0.0015). These data suggest that cardiovascular risk factors need to be closely monitored in CWH, and a better preventive strategy is likely needed to identify those hemophilic patients at higher risk of developing cardiovascular disease in adulthood.
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29
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Marchesini E, Oliovecchio E, Coppola A, Santagostino E, Radossi P, Castaman G, Valdrè L, Santoro C, Tagliaferri A, Ettorre C, Zanon E, Barillari G, Cantori I, Caimi TM, Sottilotta G, Iorio A, Mannucci PM. Comorbidities in persons with haemophilia aged 60 years or more compared with age-matched people from the general population. Haemophilia 2017; 24:e6-e10. [PMID: 29271531 DOI: 10.1111/hae.13379] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 01/04/2023]
Affiliation(s)
- E Marchesini
- Hemophilia Centre-SC Vascular and Emergency Department, University of Perugia, Perugia, Italy
| | - E Oliovecchio
- Hemophilia Centre-SC Vascular and Emergency Department, University of Perugia, Perugia, Italy
| | - A Coppola
- Regional Reference Centre for Coagulation Disorders, Federico II University Hospital, Naples, Italy.,Regional Reference Centre for inherited bleeding disorders, University Hospital of Parma, Parma, Italy
| | - E Santagostino
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - P Radossi
- Transfusion Service, Haemophilia Centre and Haematology, Castelfranco Veneto Hospital, Castelfranco Veneto, Italy
| | - G Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - L Valdrè
- Unit of Angiology and Coagulation Disorders, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - C Santoro
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - A Tagliaferri
- Regional Reference Centre for inherited bleeding disorders, University Hospital of Parma, Parma, Italy
| | - C Ettorre
- Hemophilia and Thrombosis Center, Policlinico Giovanni XXIII, Bari, Italy
| | - E Zanon
- Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Padua, Italy
| | - G Barillari
- Center for Haemorrhagic and Thrombotic Disorders, Udine General and University Hospital, Udine, Italy
| | - I Cantori
- Haemophilia Center, Regional Reference Center for inherited bleeding and thrombophilic disorders, Civil Hospital, Macerata, Italy
| | - T M Caimi
- A De Gasperis Cardiovascular Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - G Sottilotta
- Hemostasis and Thrombosis Unit, "Bianchi-Melacrino-Morelli" Metropolitan Hospital, Reggio Calabria, Italy
| | - A Iorio
- Department of Clinical Epidemiology and Biostatistics, Department of Medicine, McMaster University, Hamilton, Canada
| | - P M Mannucci
- Scientific Direction, IRCCS Ca' Granda Maggiore Hospital Foundation and University of Milan, Milan, Italy
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30
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Revascularization strategies and in-hospital management in acute coronary syndromes complicated by hemophilia A or hemophilia B. Blood Coagul Fibrinolysis 2017; 28:650-657. [DOI: 10.1097/mbc.0000000000000655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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31
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Diagnosis and care of patients with mild haemophilia: practical recommendations for clinical management. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 16:535-544. [PMID: 29328905 DOI: 10.2450/2017.0150-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/26/2017] [Indexed: 12/17/2022]
Abstract
Mild haemophilia is defined by factor levels between 0.05 and 0.40 IU/mL and is characterised by traumatic bleeds. Major issues associated with mild haemophilia are that it may not present for many years after birth, and that awareness, even within families, may be low. Methodological problems exist in diagnosis, such as inconsistencies in results obtained from different assays used to measure factor levels in mild haemophilia. Advances in genetic testing provide insight into diagnosis as well as the likelihood of inhibitor development, which is not uncommon in patients with mild or moderate haemophilia and can increase morbidity. The management of patients with mild haemophilia is a challenge. This review includes suggestions around formulating treatment plans for these patients, encompassing the full spectrum from clinical care of the newly diagnosed neonate to that of the ageing patient with multiple comorbidities. Management strategies consider not only the vast differences in these patients' needs, but also risks of inhibitor development and approaches to optimally engage patients.
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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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33
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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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34
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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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35
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Amoozgar H, Fath M, Jooya P, Karimi M. Evaluation of Heart Function in Patients With Hemophilia. Clin Appl Thromb Hemost 2017; 23:374-378. [DOI: 10.1177/1076029615614394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
There are conflicting reports about the protective effect of hemophilia on the occurrence of ischemic heart disease. This study focuses on evaluation of heart function in patients with hemophilia. Cross-sectional, case–control study was done on all patients with hemophilia A or B who came to hemophilia center, and data were compared to controls. The data were collected from their charts, and heart function was evaluated by 2-dimensional, Doppler and pulse tissue Doppler. The serum troponin I level was measured in all patients as a marker of myocardial damage. Fifty patients with hemophilia took part in this study. All of them were male with mean age 29.1 years. Systolic blood pressure (mean = 121.52 ± 11 vs 115.61 ± 9.81, P = .038) and diastolic (mean = 81.94 ± 4.51 vs 75.21 ± 3.95, P = .042) blood pressure were higher in the patients. Five (10%) patients had systolic hypertension and 7 (14%) patients had diastolic hypertension. The M-mode echocardiography results showed that interventricular septum in diastole in patients with hemophilia (mean 1.143 ± 0.29) was significantly thicker than the control group (mean 0.828 ± 0.22, P < .001). Tissue Doppler echocardiography showed that late diastolic velocity of septum (Aa; P = .030), systolic velocity (S) of lateral mitral valve ( P = .006), late diastolic velocity of lateral mitral (Aa) annulus ( P = .038), and late velocity of (Aa) tricuspid ( P = .004) had significant difference compared with the control group ( P < .05). Troponin enzyme level was < 0.1 in all patients. Patients with hemophilia had higher blood pressure and more hypertension. Echocardiographic study of patients with hemophilia showed some increase in septal thickness and changes in diastolic dysfunction
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Affiliation(s)
- Hamid Amoozgar
- Cardiac and Neonatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maedeh Fath
- Pediatric Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parisa Jooya
- Pediatric Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran Karimi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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36
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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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Abstract
As life expectancy greatly increases in persons with hemophilia (PWH), more age-related diseases such as cancer and cardiovascular disease (CVD) emerge among this patient group. The aim of this study was to review the available evidence on the epidemiology of CVD events, and incidence and survival of cancer in PWH. The prevalence of CVD events among PWH seems to be similar to that of the general population. Some known risk factors for the event, including aging, hypertension, and hyperlipidemia, are also associated with its occurrence in PWH. There is no evidence showing occurrence of the event directly to clotting factor concentrate administration. On the other hand, the incidence of non-virus related cancer seems to be higher in PWH than the general population. In addition, PWH with cancer were younger at the time of diagnosis. In regards to hemophilia effect on cancer prognosis, further basic and large-scale prospective studies are urgently needed.
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Affiliation(s)
- Jiaan-Der Wang
- Center for Rare Disease and Hemophilia, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
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38
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Berger K, Schopohl D, Lowe G, Holme PA, Tait RC, Combescure C, Rauchensteiner S, Klamroth R. How to compare cardiovascular disease and risk factors in elderly patients with haemophilia with the general population. Haemophilia 2016; 22:e406-16. [DOI: 10.1111/hae.13069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2016] [Indexed: 12/13/2022]
Affiliation(s)
- K. Berger
- Department of Haematology/Oncology; University Hospital of Munich; Munich Germany
| | - D. Schopohl
- Department of Haematology/Oncology; University Hospital of Munich; Munich Germany
| | - G. Lowe
- Haemophilia Centre; Glasgow UK
- Royal Infirmary; Glasgow UK
| | - P. A. Holme
- Department of Haematology; Oslo University Hospital and Institute of Clinical Medicine University of Oslo; Oslo Norway
| | - R. C. Tait
- Haemophilia Centre; Glasgow UK
- Royal Infirmary; Glasgow UK
| | - C. Combescure
- University Hospital and Faculty of Medicine of Geneva; Geneva Switzerland
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39
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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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40
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Altisent C, Martorell M, de la Sierra A. Sodium content in products used to treat haemophilia. Haemophilia 2016; 22:e324-e327. [PMID: 27228069 DOI: 10.1111/hae.12948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Affiliation(s)
- C Altisent
- Haemophilia Centre, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Martorell
- Haemophilia Centre, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A de la Sierra
- Department of Internal Medicine, University Hospital Mutua de Terrassa, Barcelona, Spain
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41
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Berntorp E, Hart D, Mancuso ME, d'Oiron R, Perry D, O'Mahony B, Kaczmarek R, Crato M, Pasi J, Miners A, Carlsson KS, Kitchen S, Boehlen F, Giangrande P, Cebura E, Uitslager N, Osooli M, Janeckova D, Haldon R, Rivolta GF. The first Team Haemophilia Education meeting, 2015, Amsterdam, The Netherlands. Eur J Haematol 2016; 97 Suppl 83:3-18. [DOI: 10.1111/ejh.12760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 01/12/2023]
Affiliation(s)
- Erik Berntorp
- Skåne University Hospital; Lund University; Malmö Sweden
| | - Daniel Hart
- Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - Maria Elisa Mancuso
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre; Fondazione IRCCS Ca’ Granda; Ospedale Maggiore Policlinico; Milan Italy
| | - Roseline d'Oiron
- Centre for Haemophilia and Rare Congenital Bleeding Disorders; University Hospitals Paris-Sud, AP-HP Bicêtre Hospital; Le Kremlin-Bicêtre France
| | - David Perry
- Addenbrooke's Hospital; University of Cambridge; Cambridge UK
| | | | | | | | - John Pasi
- Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - Alec Miners
- London School of Hygiene and Tropical Medicine; London UK
| | | | - Steve Kitchen
- Department of Coagulation; Royal Hallamshire Hospital; Sheffield UK
| | - Françoise Boehlen
- Haemostasis Unit; University Hospitals of Geneva; Geneva Switzerland
| | - Paul Giangrande
- Oxford Haemophilia & Thrombosis Centre; Oxford University Hospitals; Oxford UK
| | - Elizabete Cebura
- Haemophilia Treatment Centre; University Children's Hospital; Riga Latvia
| | - Nanda Uitslager
- Van Creveldkliniek; University Medical Centre; Utrecht The Netherlands
| | - Mehdi Osooli
- Skåne University Hospital; Lund University; Malmö Sweden
| | - Daniela Janeckova
- Haemophilia Treatment Centre; University Hospital Motol; Prague Czech Republic
| | - Rosie Haldon
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit; Royal Free Hospital; London UK
| | - Gianna Franca Rivolta
- Regional Reference Centre for Inherited Bleeding Disorders; University Hospital of Parma; Parma Italy
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42
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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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43
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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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44
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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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45
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Hamed AA, Shalaby MH, El-Kinawy NS, Elamawy AA, Abd El-Ghany SM. Renal Abnormalities Among Egyptian Children With Hemophilia A Using Renal Scintigraphy: Relation to Risk Factors and Disease Severity. Clin Appl Thromb Hemost 2015; 23:478-486. [PMID: 26659696 DOI: 10.1177/1076029615619484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Many risk factors may contribute to renal disease in patients with hemophilia A. AIM We aimed to evaluate functional and structural renal abnormalities among a group of Egyptian children with severe and moderate hemophilia A using technetium-99m diethylene triamine pentaacetic acid (99mTc-DTPA) and technetium-99 m dimercaptusuccinic acid (99mTc-DMSA) scan. We also aimed to determine the relation between these abnormalities and different risk factors and disease severity. PATIENTS AND METHODS Forty male patients, 16 with severe and 24 with moderate hemophilia A, were enrolled in this study. Their mean age was 10.2 ± 4.3 years (range, 5-17 years). Full history taking, clinical examination, laboratory, and radionuclide investigations including serum creatinine, blood urea nitrogen (BUN), urine analysis, creatinine clearance, 24-hour urinary protein, 99mTc-DTPA scan, and 99mTc-DMSA scan were performed to all enrolled patients. RESULTS Serum creatinine and BUN were normal in all patients, and corrected creatinine clearance was diminished in 2 patients. However, 99mTc-DTPA results yielded 19 (47.5%) patients with diminished glomerular filtration rate (GFR). Moreover, it showed that 14 (35%) had obstructive uropathy, 15 (37.5%) had obstructive nephropathy, while 11 (27.5%) patients showed normal scan. One patient had atrophy of 1 kidney on 99mTc-DMSA scan. Among our cohort, 5 (12.5%) patients were hypertensive. Microscopic hematuria was detected in 14 (35%) patients while 72.5% had proteinuria. We found an association between hematuria and hypertension with diminished GFR. CONCLUSION Despite normal kidney functions (serum creatinine and BUN), we found a high rate of diminished GFR and obstructive uropathy and nephropathy as detected by 99mTc-DTPA scan among children with hemophilia A.
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Affiliation(s)
- Ahmed Alsaeed Hamed
- 1 Department of Pediatrics, Hematology Unit, Ain Shams University, Cairo, Egypt
| | | | - Nihal Saad El-Kinawy
- 3 Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Alaa Adel Elamawy
- 1 Department of Pediatrics, Hematology Unit, Ain Shams University, Cairo, Egypt
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46
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Arachchillage DRJ, Makris M. Choosing and using non-steroidal anti-inflammatory drugs in haemophilia. Haemophilia 2015; 22:179-187. [DOI: 10.1111/hae.12805] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 12/11/2022]
Affiliation(s)
| | - M. Makris
- Sheffield Haemophilia and Thrombosis Centre; Royal Hallamshire Hospital; Sheffield UK
- Department of Cardiovascular Science; University of Sheffield; Sheffield UK
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47
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Abstract
With advances in care, increasing numbers of people with hemophilia (PWH) achieve near-normal life expectancies and present with typical age-related cardiovascular conditions. Evidence-based guidelines for medical or surgical management of cardiovascular conditions in individuals with hemophilia are limited. Published recommendations exist for the management of some common cardiovascular conditions (eg, ischemic heart disease, atrial fibrillation), but identifying optimal strategies for anticoagulant or antithrombotic therapy constitutes the primary challenge of managing nonoperative cardiovascular disease (CVD) in PWH. In general, as long as factor concentrates or other hemostatic therapies maintain adequate hemostasis, the recommended medical and surgical management of CVD in PWH parallels that in individuals without hemophilia. The presence of factor inhibitors complicates hemophilia management. Published outcomes of CVD treatment in PWH are similar to those in the general population. Specific knowledge about factor replacement, factor inhibitors, and disease-specific treatment distinguishes the cardiovascular care of PWH from similar care of individuals without this rare bleeding disorder. Furthermore, a multidisciplinary approach incorporating a hematologist with an onsite coagulation laboratory, ideally associated with a hemophilia treatment center, is integral to the management of CVD in PWH.
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48
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Canaro M, Goranova-Marinova V, Berntorp E. The ageing patient with haemophilia. Eur J Haematol 2015; 94 Suppl 77:17-22. [PMID: 25560790 DOI: 10.1111/ejh.12497] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2014] [Indexed: 01/10/2023]
Abstract
Older patients with haemophilia (PWH) face many challenges related not only to haemophilia but also to general comorbidities associated with ageing. This article discusses the clinical experience published about the high prevalence of diseases in older PWH. These conditions are managed in the general population by healthcare workers with little training in haemophilia. Haemophilic arthropathy is common in elderly PWH. Prophylaxis starting at an early age in sufficient dose regimens to prevent arthropathy did not occur in patients who are now older than around 40 yr. Many PWH above this age thus have limitations in their activities of daily life. Cardiovascular diseases have become increasingly common in the growing, ageing cohort of PWH. Lifestyle issues such as sexual dysfunction may be exacerbated by the medical issues and psychological problems associated with haemophilia. Hepatitis C virus is a leading problem in PWH. Coinfection with HIV accelerates the progression to end-stage liver disease. Acute and chronic renal failure is more common in adult PWH than in general population. Other comorbidities are reviewed. The evidence is scarce, so it is imperative to report any experience regarding the diagnosis and treatment of these entities, to improve the quality of life of older PWH.
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Affiliation(s)
- Mariana Canaro
- Thrombosis and Haemostasis Unit, Son Espases University Hospital, Palma de Mallorca, Spain
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49
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Prevalence and risk factors of atherothrombotic events among 1054 hemophilia patients: A population-based analysis. Thromb Res 2015; 135:502-7. [DOI: 10.1016/j.thromres.2014.12.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 12/05/2014] [Accepted: 12/27/2014] [Indexed: 12/17/2022]
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50
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Kulkarni R, Mauser-Bunschoten EP, Stedman C, Street A. Medical co-morbidities and practice. Haemophilia 2014; 20 Suppl 4:130-6. [PMID: 24762288 DOI: 10.1111/hae.12403] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2014] [Indexed: 11/28/2022]
Abstract
All-oral treatments of hepatitis C (HCV) have been trialled in patients with hereditary bleeding disorders and found to be effective. Further refinements of dosing and duration are being established. Importantly for patient acceptability these regimens are interferon-free. Cohort studies in older patients with haemophilia direct the need for attention to weight control, exercice, assessment of cardiovascular risk, especially hypertension and detection of osteoporosis. Where patients live a long way from a comprehensive care centre, telemedicine connections can engage centre experts with the patient and his/her local practitioners in devising and monitoring care plans.
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Affiliation(s)
- R Kulkarni
- Professor and Director Pediatric Hematology/Oncology, Michigan State University, East Lansing, MI, USA
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