Upper gastrointestinal bleeding in haemophiliacs: incidence and relation to use of non‐steroidal anti‐inflammatory drugs

Eyster, M. Elaine; ASAAD, S. M.; Gold, Ben; Cohn, Sylvia; Goedert, James J.

doi:10.1111/j.1365-2516.2007.01453.x

Cited by 37 publications

(33 citation statements)

References 38 publications

(49 reference statements)

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“…35 Upper gastrointestinal bleeding was reported to occur in 42 of 2285 PWHs (incidence, 1.3 per 100 patient-years) and the use of NSAIDs was associated with an increased bleeding risk (hazard ratio ϭ 3.7), whereas the use of COX2 inhibitors was not. 38 Hence, we prefer COX2 inhibitors to NSAIDs when paracetamol, still the drug of first choice, is not effective to control pain. An example of a pain control schedule, based on sequential steps of more and more aggressive treatment in case of failure, is given in Table 3.…”

Section: Pain Controlmentioning

confidence: 99%

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

Mannucci

Schutgens

Santagostino

et al. 2009

Blood

165

191

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In persons with hemophilia, life expectancy is now approaching that of the general male population, at least in countries that can afford regular replacement therapy with coagulation factor concentrates. The new challenges for comprehensive treatment centers are thus to provide optimal health care for this aging population of patients, who often present not only with the comorbidities typically associated with hemophilia (arthropathy, chronic pain, blood-borne infections), but also with common age-related illnesses such as cardiovascular disease and cancer. There are no evidence-based guidelines for the management of these conditions, which often require drugs that interfere with hemostasis, enhance the bleeding tendency, and warrant more intensive replacement therapy. At the moment, elderly patients with hemophilia affected by other diseases should be managed like their age-group peers without hemophilia, provided replacement therapy is tailored to the heightened risk of bleeding associated with the need for invasive procedures and drugs that further compromise the deranged hemostasis. More detailed advice is provided on the schedules of replacement therapy needed to tackle cardiovascular diseases, such as acute coronary syndromes and nonvalvular atrial fibrillation, because these conditions will become more and more frequent challenges for the comprehensive treatment centers. (Blood. 2009;114: 5256-5263)

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Section: Pain Controlmentioning

confidence: 99%

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

Mannucci

Schutgens

Santagostino

et al. 2009

Blood

165

191

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“…The absolute risk for developing UGI bleeding in a PWH remains unknown. However, in a multicentre study with 2285 patients with haemophilia, there was a 1.3% annual incidence of clinically important UGI bleeding events . This incidence is nearly 10 times greater than the 0.1% UGI bleeding rate reported in those without haemophilia (general population) (Table ).…”

Section: Introductionmentioning

confidence: 91%

“…Furthermore, it was reported that the RR of GI bleeding was significantly and independently increased with age >46 years (3.5; 95% CI: 1.1–10.6) and hepatic decompensation (4.4; 95% CI: 1.7–11.6). Presence of H. pylori positivity increased the likelihood of UGI bleeding but this did not reach statistical significance (odds ratio: 4.6; 95% CI: 0.3–83.9) . Based on these findings, the authors concluded that COX‐2 inhibitors are safer alternative analgesic and anti‐inflammatory agents for PWH with arthropathy .…”

Section: Introductionmentioning

confidence: 99%

Choosing and using non‐steroidal anti‐inflammatory drugs in haemophilia

Arachchillage

Makris

2015

Haemophilia

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The management of pain and inflammation in haemophilic arthropathy is challenging due to the lack of anti-inflammatory analgesic agents perfectly suitable for this population. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in the management of arthritis due to their analgesic and anti-inflammatory effects. Their use in persons with haemophilia (PWH), however, is limited due to increased risk of bleeding mainly from the upper gastrointestinal (UGI) tract. Cyclooxygenase-2 (COX-2) selective NSAIDs which have comparable analgesic effect to traditional NSAIDs (tNSAIDs) but with less UGI bleeding have been considered to be a suitable option for treatment of haemophilic arthropathy. COX-2 inhibitors, however, have an increased in the risk of cardiovascular (CV) disease. Although the atherosclerotic burden in PWH is similar to that in the general population, the risk of CV related deaths is lower. PWH have a higher risk of GI bleeding and lower risk of thrombotic disease compared to general population. Therefore, when PWH require antiinflammatory/analgesic agents, it seems reasonable to use lowest possible dose of COX-2 inhibitors for the shortest period with a proton pump inhibitor cover (provided they do not have renal impairment or additional risk factors for CV disease) prior to starting COX-2 inhibitors. H.pylori infection should be tested for and eradicated prior to starting NSAID treatment in PWH. Furthermore, regular blood pressure and renal function test monitoring is required during COX-2 inhibitor treatment.3

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“…29 Managing painful arthropathy with nonaddictive medications is difficult in the older hemophilia patient because of increased risks of nonsteroidal anti-inflammatory agent (NSAID)-associated gastrointestinal bleeding and acetaminophen-associated liver dysfunction. 30,31 In one study, the use of nonselective NSAIDs was associated with an increased likelihood of bleeding, whereas selective COX2 inhibitors were not. 30 The extent of use of long-term continued factor prophylaxis initiated after multiple joint bleeds and established joint damage, so-called "secondary" prophylaxis, in adults over 45 is unknown; its effectiveness in mitigating hemophilic arthropathy is also unknown.…”

Section: Joint Diseasementioning

confidence: 99%

“…30,31 In one study, the use of nonselective NSAIDs was associated with an increased likelihood of bleeding, whereas selective COX2 inhibitors were not. 30 The extent of use of long-term continued factor prophylaxis initiated after multiple joint bleeds and established joint damage, so-called "secondary" prophylaxis, in adults over 45 is unknown; its effectiveness in mitigating hemophilic arthropathy is also unknown. A European survey found that 23% (58 out of 251) of severe hemophiliacs over 50 years of age were on a regimen of regular concentrate administration, 32 but this may not be similar in the United States, given the variation between the United States and some European countries in prophylaxis practice patterns for pediatric hemophilia patients.…”

Section: Joint Diseasementioning

confidence: 99%

The Aging Patient with Hemophilia: Complications, Comorbidities, and Management Issues

Philipp

2010

Hematology

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Improvements in hemophilia care and antiviral treatments have resulted in increases in median life expectancy for persons with congenital hemophilia A and B. Currently, 2% of hemophilia A and B patients surveyed in US comprehensive hemophilia treatment centers are 65 years of age or older and 15% are 45 years or older. Many of the complications of hemophilia, including intracranial hemorrhage, joint disease, and inhibitor development, increase with increasing age. Hepatocellular carcinoma and end-stage liver disease are increasing in the older hemophilia population due to infection with hepatitis C (HCV) and HCV/HIV coinfection. Older hemophilia patients also now face the same medical conditions associated with aging in the general population, including cardiovascular disease and cancer. Complex hemostatic management, sometimes in conjunction with antithrombotic management, with extensive cross-specialty clinical and laboratory coordination may be required for the care of the older hemophilia patient. Because elderly hemophilia patients currently represent a small portion of the overall hemophilia population, there is little in the way of clinical data to guide recommendations. Registry databases and cooperative group studies are needed for the development of evidence-based guidelines for the older hemophilia population, which is anticipated to expand in the future.

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Upper gastrointestinal bleeding in haemophiliacs: incidence and relation to use of non‐steroidal anti‐inflammatory drugs

Cited by 37 publications

References 38 publications

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

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

Choosing and using non‐steroidal anti‐inflammatory drugs in haemophilia

The Aging Patient with Hemophilia: Complications, Comorbidities, and Management Issues

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