Outcomes of COVID-19 in Adult Males With Hemophilia A: A Propensity Score-Matched Analysis

Abstract

BackgroundHypercoagulability is a major pathologic event in COVID-19. Factor VIII plays an important role in hemostasis, and high levels of factor VIII have been shown to be associated with an increased risk of thrombosis and severe disease. Little is known about the impact of COVID-19 on clinical outcomes in patients with hemophilia A. MethodologyRetrospective data of adult male patients with COVID-19 with and without hemophilia A were retrieved from the TriNetX database (Cambridge, USA). The 1:1 propensity score-matching was performed to balance baseline characteristics. Patients were matched for age, race, body mass index, and medical comorbidities. Thirty-day outcomes were assessed. ResultsWe identified 1,758 patients with pre-existing hemophilia A diagnosis prior to COVID-19 diagnosis and 5,191,908 comparators. After 1:1 propensity score matching, groups were balanced on demographics and comorbidities. All-cause mortality rates were similar between the two groups (HR 0.805; 95% CI 0.467-1.389). The frequency of severe infection, ICU admission, and composite thrombotic events did not differ between the groups. Patients with hemophilia A were hospitalized more frequently than those without a history of hemophilia A (19.2% vs. 14.4%; p<0.05). Additionally, gastrointestinal (GI) bleeding and composite bleeding events occurred more frequently in patients with hemophilia A (3.2% vs. 2.2%; p<0.05 and 4.0% vs. 2.8%; p<0.05, respectively). ConclusionsThe mortality of individuals with hemophilia A due to COVID-19 is comparable to the general population but with higher risks of hospitalization and bleeding.

Hematological Complications in a COVID-19 Patient: A Case Report

“…A retrospective study in hemophilia A patients reported that COVID-19 is linked to a higher risk of bleeding and hospitalizations [31] due to the possible development of FVIII inhibitors after an immune trigger [20].…”

Blood Coagulation and Thrombotic Disorders following SARS-CoV-2 Infection and COVID-19 Vaccination

“…Since COVID-19 is associated with coagulation and thrombotic disorders, little was known about the infection's impact on the clinical outcomes of patients with hemophilia. A retrospective study by Mericliler et Narayan with 1758 adult male patients reported that COVID-19 did not increase the mortality of COVID-19 in hemophilia A patients but increased the risk of bleeding and hospitalizations [35].…”