51. The bleeding phenotype in people with nonsevere hemophilia
- Author
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Fabienne R. Kloosterman, Anne-Fleur Zwagemaker, Catherine N. Bagot, Erik A. M. Beckers, Giancarlo Castaman, Marjon H. Cnossen, Peter W. Collins, Charles Hay, Michel Hof, Britta Laros-van Gorkom, Frank W. G. Leebeek, Christoph Male, Karina Meijer, Ingrid Pabinger, Susan Shapiro, Michiel Coppens, Karin Fijnvandraat, Samantha C. Gouw, Internal medicine, Pediatrics, APH - Methodology, ACS - Pulmonary hypertension & thrombosis, Hematology, Graduate School, Paediatric Haematology, Paediatrics, Epidemiology and Data Science, Vascular Medicine, ACS - Amsterdam Cardiovascular Sciences, Landsteiner Laboratory, ARD - Amsterdam Reproduction and Development, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Interne Geneeskunde, MUMC+: MA Hematologie (9), and RS: Carim - B01 Blood proteins & engineering
- Subjects
Adult ,Male ,Adolescent ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Hemorrhage ,Hematology ,Middle Aged ,Hemophilia A ,Hemostatics ,Factor IX ,Young Adult ,Phenotype ,Hemophilia A/complications ,Hemarthrosis ,Humans ,Hemorrhage/etiology ,Child ,Hemarthrosis/etiology - Abstract
Detailed information on the onset, frequency, and severity of bleeding in nonsevere hemophilia is limited. We aimed to assess the bleeding phenotype of persons with nonsevere hemophilia and to analyze the association between baseline factor VIII/IX (FVIII/IX) levels and the joint bleeding rate. In the DYNAMO (Dynamic Interplay Between Bleeding Phenotype and Baseline Factor Level in Moderate and Mild Hemophilia A and B) study, an international multicenter cohort, we included males with nonsevere hemophilia (FVIII/IX, 0.02-0.35 IU/mL) aged 12 to 55 years. Information on age at first treated (joint) bleed, annual bleeding rates (ABRs), and annual joint bleeding rates (AJBRs) was collected from the medical files. The association between baseline FVIII/IX levels and the joint bleeding rate was assessed by using a frailty model for recurrent events. In total, 304 persons (70 with moderate hemophilia and 234 with mild hemophilia) were included. The median age was 38 years (interquartile range [IQR], 25-49 years), and the median baseline FVIII/IX level was 0.12 IU/mL (IQR, 0.05-0.21 IU/mL). In total, 245 (81%) persons had experienced at least 1 bleed, and 156 (51%) had experienced at least 1 joint bleed. The median age at first bleed and first joint bleed was 8 and 10 years, respectively. The median ABR and AJBR was 0.2 (IQR, 0.1-0.5) and 0.0 (IQR, 0.0-0.2). From baseline FVIII/IX levels 0.02 to 0.05 IU/mL to >0.25 IU/mL, the median ABR decreased from 0.6 (IQR, 0.2-1.4) to 0.1 (IQR, 0.0-0.2) and the AJBR from 0.2 (IQR, 0.0-0.4) to 0.0 (IQR, 0.0-0.0). Baseline FVIII/IX was inversely associated with the joint bleeding rate (P < .001). Low bleeding rates were observed in persons with nonsevere hemophilia. However, one-half of all adolescents and adults had experienced a joint bleed.
- Published
- 2022