Non-fatal cardiovascular disease, malignancies, and other co-morbidity in adult haemophilia patients

Putte, Dietje E. Fransen van de; Fischer, Kathelijn; Pulles, Astrid E; Roosendaal, G.; Biesma, Douwe H.; Schutgens, Roger E. G.; Mauser‐Bunschoten, Eveline P.

doi:10.1016/j.thromres.2011.12.012

Cited by 47 publications

(73 citation statements)

References 17 publications

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“…This is in line with observations that ischaemic cardiovascular disease is seen more frequently in mild haemophilia as compared to severe [19,20]. This is in line with observations that ischaemic cardiovascular disease is seen more frequently in mild haemophilia as compared to severe [19,20].…”

Section: Resultssupporting

confidence: 92%

Atrial fibrillation in patients with haemophilia: a cross‐sectional evaluation in Europe

et al. 2014

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Atrial fibrillation (AF) is a common health problem in the general population, but data on prevalence or management in patients with haemophilia (PWH) are lacking. The aims of this study were to analyse the prevalence of AF and risk factors for stroke using a cross-sectional pan-European design and to document current anticoagulation practice. The ADVANCE Working Group consists of members from 14 European haemophilia centres. Each centre retrieved data on their PWH with AF. From the total of 3952 adult PWH, 33 had AF with a mean age of 69 years (IQR 62-76). Haemophilia was severe in seven (21%), moderate in six (18%) and mild in 20 (61%) patients. The overall AF prevalence was 0.84% and increased with age; 0.42% in patients 40-60 years and 3.4% in patients >60 years. The mean CHA2 DS2 -Vasc score was 1.3 (range 0-4), predominantly determined by age and hypertension. Hypertension was reported in 48% of PWH with AF. In 11 patients (33%), anticoagulation was started of whom nine aspirin and two vitamin K antagonists. Of these 11 patients, nine had mild haemophilia. Anticoagulation was given in 42% of patients with a CHA2 DS2 -Vasc score ≥2. During follow-up (mean 57 months), there were no thrombotic events reported, nor increases in bleeding severity. The prevalence of AF in haemophilia increases with age and is predominantly present in mild haemophilia. PWH have a low stroke risk based on their CHA2 DS2 -Vasc scores, that might be even lower considering the hypocoagulable state. Only 33% of PWH with AF receives any form of anticoagulation therapy.

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Section: Resultssupporting

confidence: 92%

Atrial fibrillation in patients with haemophilia: a cross‐sectional evaluation in Europe

et al. 2014

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“…Some publication bias in the reviews might have occurred. Most case reports concerned patients with severe haemophilia, whereas, in a recent publication, myocardial infarction was shown to occur more often in patients with moderate or mild haemophilia . In the current case series, no patients with severe haemophilia and IHD presented.…”

Section: Discussionmentioning

confidence: 44%

Cardiac catheterization and intervention in haemophilia patients: prospective evaluation of the 2009 institutional guideline

et al. 2013

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Ageing haemophilia patients are increasingly confronted with ischaemic heart disease (IHD). Treatment is complex because of the delicate equilibrium between bleeding and thrombosis. In 2009, we developed an institutional guideline on how to treat IHD in this patient population. The aim of this study was to evaluate feasibility and safety of this guideline. Haemophilia patients who underwent coronary angiography or percutaneous coronary intervention between January 2009 and June 2012 were included in the current case series. Nine diagnostic or therapeutic cardiac catheterizations were performed in six haemophilia patients. One patient with moderate haemophilia B was included, whereas the other patients had mild haemophilia A. In six of nine procedures, access to the circulation was gained via the radial artery. Only bare-metal stents were implanted, after which dual antiplatelet treatment was given for at least 4 weeks. During cardiac catheterization/intervention and dual antiplatelet treatment, clotting factor levels were corrected. No thrombotic or clinically relevant bleeding complications occurred. In one patient, a low-titre inhibitor recurred 10 months after catheterization. In-stent restenosis was diagnosed in one patient. This case series indicates that treatment according to the guideline is feasible and safe. Furthermore, based on the case series and developments in new guidelines for non-haemophilic patients with IHD, some adjustments on the 2009 guideline are proposed.

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“…On the other hand, the frequency and severity of bleeding may increase if more surgical procedures or treatments with antiplatelet and anticoagulant drugs or chemotherapy are needed because of co-morbidities. In our cohort of 71 elderly patients, HIV did not occur and chronic hepatitis B and C infections were rare, but higher than in the general population, with a prevalence of 0.4% and 0.002%, respectively [33,34]. This is in contrast to elderly hemophilia patients [11,35], in whom the prevalence of HIV infections ranges from 3.5% to 13%, and that of hepatitis C infections ranges from 69% to 92% [30,36].…”

Section: Discussionmentioning

confidence: 80%

von Willebrand disease and aging: an evolving phenotype

Sanders

Giezenaar

Gorkom

et al. 2014

Journal of Thrombosis and Haemostasis

136

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Summary. Background: Because the number of elderly von Willebrand disease (VWD) patients is increasing, the pathophysiology of aging in VWD has become increasingly relevant. Objectives: To assess age-related changes in von Willebrand factor (VWF) and factor VIII (FVIII) levels and to compare age-related differences in bleeding phenotype between elderly VWD patients and those < 65 years. We also studied co-morbidity in elderly patients. Patients/ Methods: We included VWD patients with VWF levels ≤ 30 U dL À1 in the nationwide cross-sectional 'Willebrand in the Netherlands' (WiN-) study. Patients reported bleeding episodes and treatment of VWD in the year preceding inclusion and during life. This was compared between VWD patients older (n = 71) and younger (16-64 years, n = 593) than 65 years. In elderly patients, agerelated changes in VWF and FVIII levels were studied longitudinally by including all historically measured levels. All medical records were examined for co-morbidity. Results: In elderly type 1 patients, a decade age increase was associated with a 3.5 U dL À1 (95% CI, À0.6 to 7.6) VWF:Ag increase and 7.1 U dL À1 (95% CI, 0.7 to 13.4) FVIII:C increase. This increase was not observed in elderly type 2 patients. Elderly type 2 patients reported significantly more bleeding symptoms in the year preceding inclusion than younger patients (16/27, 59% vs. 87/ 221, 39%; P = 0.048), which was not observed in type 1 VWD. Conclusions: von Willebrand factor parameters and bleeding phenotype evolve with increasing age in VWD. VWF and FVIII levels increase with age in type 1 patients with no mitigation in bleeding phenotype. In type 2 patients VWF parameters do not increase with age and in these patients aging is accompanied by increased bleeding.

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Non-fatal cardiovascular disease, malignancies, and other co-morbidity in adult haemophilia patients

Cited by 47 publications

References 17 publications

Atrial fibrillation in patients with haemophilia: a cross‐sectional evaluation in Europe

Atrial fibrillation in patients with haemophilia: a cross‐sectional evaluation in Europe

Cardiac catheterization and intervention in haemophilia patients: prospective evaluation of the 2009 institutional guideline

von Willebrand disease and aging: an evolving phenotype

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