Management of atrial fibrillation in people with haemophilia – a consensus view by the <scp>ADVANCE</scp> Working Group

Schutgens, Roger E. G.; Klamroth, Robert; Pabinger, Ingrid; Dolan, G.

doi:10.1111/hae.12525

Cited by 22 publications

(40 citation statements)

References 10 publications

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“…A FVIII level of 20% was used as the cut‐off value. According to the Receiver Operator Curve (area under the curve, 0.673; 95% CI, 0.578–0.768) a cut‐off value of FVIII 10% is superior in predicting ETP < 400, but the cut‐off of FVIII 20% was used because of clinical considerations and the high risk of bleeding at FVIII levels up to 12% . Results of ETP according to FVIII cut‐off levels of 5%, 10% and 15% are shown in the supplemental material (Table S1).…”

Section: Discussionmentioning

confidence: 99%

Comparing thrombin generation in patients with hemophilia A and patients on vitamin K antagonists

Koning

Fischer

Laat

et al. 2017

Journal of Thrombosis and Haemostasis

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Essentials It is unknown if hemophilia patients with atrial fibrillation need anticoagulation. Endogenous thrombin potentials (ETP) in hemophilia patients and patients on coumarins were compared. Severe hemophilia patients had comparable ETP to therapeutic international normalized ratio (INR). In non-severe hemophilia, 33% had higher ETP than therapeutic INR and may need anticoagulation. Click to hear Dr Negrier's perspective on global assays for assessing coagulation SUMMARY: Background It is unknown whether patients with hemophilia A with atrial fibrillation require treatment with vitamin K antagonists (VKAs) to the same extent as the normal population. Objective To compare hemostatic potential in hemophilia patients and patients on VKAs using thrombin generation (TG). Methods In this cross-sectional study, TG, initiated with 1pM tissue factor, was measured in 133 patients with severe (FVIII < 1%, n = 15) and non-severe (FVIII 1-50%, n = 118) hemophilia A, 97 patients on a VKA with an international normalized ratio (INR) ≥ 1.5 and healthy controls. Endogenous thrombin potential (ETP) (nm*min) was compared according to FVIII level (< 1%, 1-19% and 20-50%) with healthy controls and patients with sub-therapeutic INR (1.5-1.9) and therapeutic INR (≥ 2.0). Medians and interquartile ranges (IQRs) were calculated. Results Compared with healthy controls (898 [IQR 803-1004]), both hemophilia patients and patients on VKAs had lower median ETPs at 304 (196-449) and 176 (100-250), respectively. ETP was quite similar in severe hemophilia patients (185 [116-307]) and patients with a therapeutic INR (156 [90-225]). Compared with patients with therapeutic INR, ETP in patients with FVIII 1-19% and patients with FVIII 20-50% was higher at 296 (203-430) and 397 (219-632), respectively. All patients with therapeutic INR had an ETP < 400. Considering this threshold, 93% of severe hemophilia patients, 70% of patients with FVIII 1-19% and 52% of patients with FVIII 20-50% had an ETP < 400. Conclusion In severe hemophilia patients, TG was comparable to that in patients with a therapeutic INR. In one-third of non-severe hemophilia patients, TG was higher. These results suggest that anticoagulation therapy should be considered in a substantial proportion of non-severe hemophilia patients.

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Section: Discussionmentioning

confidence: 99%

Comparing thrombin generation in patients with hemophilia A and patients on vitamin K antagonists

Koning

Fischer

Laat

et al. 2017

Journal of Thrombosis and Haemostasis

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“…The CHA 2 DS 2 Vasc score should be used, but it may overestimate stroke risk in PWH [24]. Conversely, the HAS-BLED score should not be used in PWH as it would substantially underestimate the bleeding risk [24].…”

Section: Patients With Coagulation Disordersmentioning

confidence: 99%

“…The definition of very high risk has to be determined individually and cannot be determined by a single parameter [24]. Of note, there are no data for the use of NOACs in PWH.…”

Section: Patients With Coagulation Disordersmentioning

confidence: 99%

Non-vitamin K antagonist oral anticoagulants in patients with an increased risk of bleeding

Gremmel

Niessner

Domanovits

et al. 2018

Wien Klin Wochenschr

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The non-vitamin K antagonist oral anticoagulants (NOACs) have considerably changed clinical practice and are increasingly being used as an alternative to vitamin K antagonists (VKAs) for 3 main reasons: 1) an improved benefit-risk ratio (in particular lower rates of intracranial bleeding), 2) a more predictable effect without the need for routine monitoring, and 3) fewer food and drug interactions compared with VKAs. Currently, there are four NOACs available: the factor Xa inhibitors apixaban, edoxaban, and rivaroxaban, and the thrombin inhibitor dabigatran. This consensus paper reviews the properties and usage of NOACs in a number of high-risk patient populations, such as patients with chronic kidney disease, patients ≥80 years of age and others and provides guidance for the use of NOACs in patients at risk of bleeding.

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“…Jemanje Aspirina® naj bi bilo varno pri lahki hemofiliji oz. aktivnosti FVIII ali IX nad 5 %, jemanje kumarinov pa pri aktivnosti FVIII ali IX nad 30 % (298), čeprav imajo nekateri centri tudi dobre izkušnje z niž-jimi tarčnimi ravnmi faktorja VIII ali IX (295,299).…”

Section: Kardiovaskularne Bolezni (Kvb)unclassified

Nacionalna priporočila za obravnavo bolnikov s hemofilijo

et al. 2017

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The document presents recommendations for the comprehensive treatment of patients with haemophilia in Slovenia. It enables health workers at all three levels of health care to become well-acquainted with all the possible aspects of treatment based on the best practices of major centres worldwide, and on the studies and experience of health professionals at the National Haemophilia Centre, University Medical Center Ljubljana. The document contains definitions, treatment algorithms and lists of medications with their characteristics and appropriate dosages. It specifically defines indications for the exclusive competence of the tertiary level in Ljubljana due to the actual availability of teams and laboratory options. It also contains an extensive list of the literature on haemophilia.

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Management of atrial fibrillation in people with haemophilia – a consensus view by the ADVANCE Working Group

Cited by 22 publications

References 10 publications

Comparing thrombin generation in patients with hemophilia A and patients on vitamin K antagonists

Comparing thrombin generation in patients with hemophilia A and patients on vitamin K antagonists

Non-vitamin K antagonist oral anticoagulants in patients with an increased risk of bleeding

Nacionalna priporočila za obravnavo bolnikov s hemofilijo

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