Comorbidities and bleeding pattern in elderly haemophilia A patients

Abstract

The increasing numbers of comorbidities related to higher age and their treatment constitute a challenge in the treatment of haemophiliacs. Comparing prevalences of morbidities in the elderly haemophilia A population (n = 29) and the general elderly population of Germany reveals some differences. HCV infections are more frequent in the elderly haemophilia population (69% vs. 0.6%). Prevalence of cancer was five times higher than in the age matched general population (28% vs. 5.2%). Cardiac diseases seem to be less frequent although the prevalences of cardiovascular risk factors like hypertension, diabetes, and body mass index (BMI) >25 do not differ in comparison to the general population. A reduction of bleeding symptoms or dosage of FVIII could not be observed. There is a tendency of increasing bleeding symptoms with increasing age of the patients due to more frequent spontaneous joint bleedings, malignancies or treatment with phenprocoumon or ASA. In consequence, FVIII dosage had to be increased in eight patients (28%). Our patient population at the age >60 years is very small and no statistical evidence can be shown, therefore appropriate treatment of elderly haemophiliacs needs further evaluation in multicentre studies with sufficient patient numbers.

Efficacy and safety of secondary prophylactic vs. on‐demand sucrose‐formulated recombinant factor VIII treatment in adults with severe hemophilia A: results from a 13‐month crossover study

“…A recent study reported a tendency toward increased bleeding symptoms with increasing age, suggesting a benefit from initiating prophylaxis in elderly hemophilic patients [19]. Translating the results of pediatric studies to adults is complicated by changes in treatment patterns that tend to occur around puberty, including interruptions or temporary discontinuations of treatment [13].…”

How I treat age-related morbidities in elderly persons with hemophilia

“…46 Two population studies found a lower incidence of cancer, particularly in patients with severe hemophilia, 4,7 but the prevalence of tumors other than HCC and non-Hodgkin lymphoma was 4-fold higher than in the age-matched general population in a small study of elderly PWHs. 47 Literature data on the treatment of cancer in elderly PWHs are limited to a few case reports, so that there is no evidence-based recommendation for the optimal management of these cases. Cancer that develops in the elderly PWH should be handled as in any other person with the same type of malignancy, but this logical approach is not without problems.…”

Von Willebrand Disease in the elderly: clinical perspectives

“…Hemophilia patients exposed to HCV and HIV have increased risk of malignancies related to these exposures, such as hepatocellular carcinoma and lymphoma 79,80. Treatment plans for malignancies in patients with hemophilia can be successfully customized to reduce bleeding risk related to chemotherapy-induced thrombocytopenia 81.…”