1
|
van der Valk PR, Mauser-Bunschoten EP, van der Heijden JF, Schutgens REG. Catheter Ablation for Atrial Fibrillation in Patients with Hemophilia or von Willebrand Disease. TH Open 2019; 3:e335-e339. [PMID: 31656943 PMCID: PMC6813037 DOI: 10.1055/s-0039-1698756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/05/2019] [Indexed: 11/30/2022] Open
Abstract
Background
Management of atrial fibrillation (AF) is complex in patients with bleeding disorders. Catheter ablation such as pulmonary vein isolation (PVI) has been suggested in cases with bleeding disorders. However, data on safety are missing. This report describes the outcome of PVI in patients with bleeding disorders.
Methods
A retrospective study in our hemophilia treatment center of patients who underwent a PVI in 2014 to 2018. PVI was done according to local protocol. Clotting factor was given periprocedural. Postprocedural anticoagulation was given for at least 4 weeks, with clotting factor suppletion if needed to maintain factor VIII (FVIII) levels >0.20 IU/mL.
Results and Discussion
Five patients with hemophilia and one with von Willebrand disease were included. Eight PVIs were performed. Target FVIII levels (>0.80 IU/mL) were met before the procedure. Postprocedural anticoagulation was given: vitamin K antagonist (VKA) or direct oral anticoagulant (DOAC) dabigatran. All patients obtained long-term sinus rhythm, in two patients after a second PVI. However, late recurrent AF occurred in one patient after 42 months. A notable incidence of groin bleeds was observed: two of eight interventions (25%) compared with 0.9% in the general population. Bleeding seemed to be related to agitation, early mobilization, and bridging of VKA with low molecular weight heparin (LMWH). No relevant bleeding was observed when on DOAC therapy.
Conclusion
PVI seems to be effective in the case of bleeding disorders. To reduce the groin bleeds agitation and early mobilization should be avoided and DOAC is preferred over bridging VKA with LMWH.
Collapse
Affiliation(s)
- Paul R van der Valk
- Van Creveldkliniek, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | | | | | - Roger E G Schutgens
- Van Creveldkliniek, University Medical Center, University Utrecht, Utrecht, The Netherlands
| |
Collapse
|
2
|
Boender J, Eikenboom J, van der Bom JG, Meijer K, de Meris J, Fijnvandraat K, Cnossen MH, Laros-van Gorkom BAP, van Heerde WL, Mauser-Bunschoten EP, de Maat MPM, Leebeek FWG. Clinically relevant differences between assays for von Willebrand factor activity. J Thromb Haemost 2018; 16:2413-2424. [PMID: 30358069 DOI: 10.1111/jth.14319] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Indexed: 01/07/2023]
Abstract
Essentials It is unclear whether there are differences between von Willebrand factor (VWF) activity assays. We compared the four most used VWF activity assays in 661 von Willebrand disease (VWD) patients. All assays correlated excellently, but a discrepant classification was seen in 20% of patients. Differences between VWF activity assays have a large impact on the classification of VWD. SUMMARY: Background Measuring the ability of von Willebrand factor (VWF) to bind to platelets is crucial for the diagnosis and classification of von Willebrand disease (VWD). Several assays that measure this VWF activity using different principles are available, but the clinical relevance of different assay principles is unclear. Objective To compare the four most widely used VWF activity assays in a large VWD patient population. Methods We measured VWF:RCo (ristocetin to activate VWF + whole platelets), VWF:GPIbR (ristocetin + platelet glycoprotein Ib receptor [GPIb] fragments), VWF:GPIbM (gain-of-function GPIb fragments that bind VWF spontaneously without ristocetin) and VWF:Ab (monoclonal antibody directed against the GPIb binding epitope of VWF to mimic platelets) in 661 VWD patients from the nationwide 'Willebrand in the Netherlands' (WiN) Study. Results All assays correlated excellently (Pearson r > 0.9), but discrepant results led to a different classification for up to one-fifth of VWD patients. VWF:RCo was not sensitive enough to classify 18% of patients and misclassified half of genotypic 2B VWD patients, especially those with p.Arg1306Trp. VWF:GPIbR was more sensitive, accurately classified the vast majority of patients, and was unaffected by the p.Asp1472His variant that causes artificially low VWF:RCo. VWF:GPIbM was the most precise assay but misclassified over a quarter of genotypic 2A, 2B and 3 patients. VWF:Ab, often not considered an actual VWF activity assay, performed at least equally to the other assays with regard to accurate VWD classification. Conclusion Although the different VWF activity assays are often considered similar, differences between assays have a large impact on the classification of VWD.
Collapse
Affiliation(s)
- J Boender
- Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - J Eikenboom
- Internal Medicine, Division, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - J G van der Bom
- Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Sanquin Research, Jon J van Rood Center for Clinical Transfusion Medicine, Leiden, the Netherlands
| | - K Meijer
- Hematology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J de Meris
- Netherlands Hemophilia Society, Nijkerk, the Netherlands
| | - K Fijnvandraat
- Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
- Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands
| | - M H Cnossen
- Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - W L van Heerde
- Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E P Mauser-Bunschoten
- University Medical Center Utrecht, van Creveld Kliniek, University Utrecht, Utrecht, the Netherlands
| | - M P M de Maat
- Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - F W G Leebeek
- Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
3
|
Makris M, Oldenburg J, Mauser-Bunschoten EP, Peerlinck K, Castaman G, Fijnvandraat K. The definition, diagnosis and management of mild hemophilia A: communication from the SSC of the ISTH. J Thromb Haemost 2018; 16:2530-2533. [PMID: 30430726 DOI: 10.1111/jth.14315] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/19/2018] [Indexed: 02/03/2023]
Affiliation(s)
- M Makris
- Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - J Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
| | | | - K Peerlinck
- Department of Vascular Medicine and Haemostasis, Haemophilia Centre, University Hospitals Leuven, Leuven, Belgium
| | - G Castaman
- Centre for Bleeding Disorders, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - K Fijnvandraat
- Department of Pediatric Hematology, Academic Medical Centre, Amsterdam, the Netherlands
| |
Collapse
|
4
|
Atiq F, Mauser-Bunschoten EP, Eikenboom J, van Galen KPM, Meijer K, de Meris J, Cnossen MH, Beckers EAM, Laros-van Gorkom BAP, Nieuwenhuizen L, van der Bom JG, Fijnvandraat K, Leebeek FWG. Sports participation and physical activity in patients with von Willebrand disease. Haemophilia 2018; 25:101-108. [PMID: 30427095 PMCID: PMC7379650 DOI: 10.1111/hae.13629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/10/2018] [Accepted: 10/09/2018] [Indexed: 01/19/2023]
Abstract
Introduction Patients with bleeding disorders may experience limitations in sports participation and physical activity. Several studies on sports participation have been performed in haemophilia patients, but studies in patients with von Willebrand disease (VWD) are lacking. Aim We assessed the sports participation and physical activity of a large cohort of VWD patients. Methods Patients were included from the “WiN study.” All patients completed a questionnaire on sports participation, physical activity, quality of life and bleeding symptoms (Tosetto bleeding score). Results From the 798 included patients, 474 had type 1, 301 type 2 and 23 type 3 VWD. The mean age was 39 ± 20 (standard deviation) years. Five hundred and fifty‐two patients (69.3%) participated in various types of sports. Type 3 VWD patients more often did not participate in sports due to fear of bleeding and physical impairment, respectively, OR = 13.24 (95% CI: 2.45‐71.53) and OR = 5.90 (95% CI: 1.77‐19.72). Patients who did not participate in sports due to physical impairment had a higher bleeding score item for joint bleeds 1.0 (±1.6) vs 0.5 (± 1.1) (P = 0.036). Patients with type 3 VWD and patients with a higher bleeding score frequently had severe limitations during daily activities, respectively, OR = 9.84 (95% CI: 2.83‐34.24) and OR = 1.08 (95% CI: 1.04‐1.12). Conclusion The majority of VWD patients participated in sports. Patients with type 3 VWD, a history of joint bleeds and a more severe bleeding phenotype frequently experienced limitations in sports participation and physical activities during daily life.
Collapse
Affiliation(s)
- Ferdows Atiq
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jeroen Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.,Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Karin P M van Galen
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karina Meijer
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joke de Meris
- Netherlands Hemophilia Patient Society, Leiden, The Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Hematology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Erick A M Beckers
- Department of Internal Medicine, Maastricht University Medical Center Plus, Maastricht, The Netherlands
| | | | | | - Johanna G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin Research, Leiden, The Netherlands
| | - Karin Fijnvandraat
- Pediatric Hematology, Emma Children's Hospital-Academic Medical Center, Amsterdam, The Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | |
Collapse
|
5
|
van Deukeren D, Mauser-Bunschoten EP, Schutgens REG, Eikenboom J, Meijer K, Fijnvandraat K, Laros-van Gorkom BAP, Cnossen M, de Meris J, van der Bom JG, Leebeek FWG, van Galen KPM. The prevalence and burden of hand and wrist bleeds in von Willebrand disease. Haemophilia 2018; 25:e35-e38. [PMID: 30394622 DOI: 10.1111/hae.13632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/28/2018] [Accepted: 10/12/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Désirée van Deukeren
- Department of Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Eveline P Mauser-Bunschoten
- Department of Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Roger E G Schutgens
- Department of Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Jeroen Eikenboom
- Department of Thrombosis and Hemostasis and Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Karina Meijer
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Amsterdam Medical Center Emma Children's Hospital, Amsterdam, The Netherlands.,Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands
| | | | - Marjon Cnossen
- Department of Pediatric Hematology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Joke de Meris
- Dutch Society of Haemophilia Patients, Leiden, The Netherlands
| | - Johanna G van der Bom
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin Research, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frank W G Leebeek
- Department of Haematology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Karin P M van Galen
- Department of Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| |
Collapse
|
6
|
Kremer Hovinga ICL, Schutgens REG, van der Valk PR, van Vulpen LFD, Mauser-Bunschoten EP, Fischer K. Continuous infusion of extended half-life factor VIII (efmoroctocog alpha) for surgery in severe haemophilia A. Haemophilia 2018; 24:e280-e283. [PMID: 30044044 DOI: 10.1111/hae.13557] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2018] [Indexed: 12/18/2022]
Affiliation(s)
- I C L Kremer Hovinga
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - R E G Schutgens
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - P R van der Valk
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - L F D van Vulpen
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - E P Mauser-Bunschoten
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - K Fischer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
7
|
Mauser-Bunschoten EP, Rosendaal FR, Nieuwenhuis HK, Roosendaal G, Briëf E, van den Berg HM. Clinical Course of Factor VIII Inhibitors Developed after Exposure to a Pasteurised Dutch Concentrate Compared to Classic Inhibitors in Hemophilia A. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1642508] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryAfter the introduction of a new pasteurised factor VIII concentrate (Factor VIII CPS-P) in The Netherlands in June 1990, an increase in the occurrence of inhibitors in hemophilia A patients was reported. The clinical course of this group of inhibitors (n = 12) was compared with hemophilia patients in whom an inhibitor developed before June 1990 (classic inhibitors) (n = 32). Striking differences were found between both groups not only in patient age (median 22 years versus 8 years) and number of exposure days (<50 − >1000 versus <50), as described in previous reports, but also in clinical course and response to treatment. In the recent group of inhibitors antibody titers showed a rapid decline when product was changed which was not the case in the group with classic inhibitors. In the group of classic inhibitors immune tolerance therapy with low dose factor VIII succeeded in 83%. Success was to a high degree dependent on the inhibitor level. In the group of recent inhibitors immune tolerance with the same concentrate was only successful in a single patient. However, once the patients were switched to another concentrate, antibody levels dropped to less than 2 BU/ml within 8 months in all patients.It seems likely that in this group of product associated inhibitors, treatment success was due to elimination of antigen stimulation rather than induction of immune tolerance.
Collapse
Affiliation(s)
| | - F R Rosendaal
- Department of Clinical Epidemiology, University Hospital, Leiden, The Netherlands
- Department of Hematology, University Hospital, Leiden, The Netherlands
| | - H K Nieuwenhuis
- Department of Hematology, University Hospital, Utrecht, The Netherlands
| | - G Roosendaal
- The Van Creveld Clinic, University Hospital, Leiden, The Netherlands
| | - E Briëf
- Department of Hematology, University Hospital, Leiden, The Netherlands
| | - H M van den Berg
- The Van Creveld Clinic, University Hospital, Leiden, The Netherlands
| |
Collapse
|
8
|
Abstract
SummaryRecently, clotting factor preparations transmitted hepatitis A virus (HAV) to hemophilia patients. To study the risk of HAV infection in Dutch hemophilia patients, serum samples of 341 patients with hemophilia were tested for HAV antibodies (anti-HAV).197/341 patients (group 1) were treated with clotting factor concentrates produced from large plasma pools, 144/341 patients (group 2) were treated with small pool cryoprecipitate. The test results were compared to those of healthy blood donors (n = 19,746) of the same age. In addition stored serum samples (1983-1994) from hemophilia patients were tested for HAV antibodies.No increased risk of HAV infection was found in Dutch hemophilia patients. The anti-HAV prevalence in group 1 was 20%, in group 213% and in blood donors 41%. A significantly (p <0.002) lower percentage of HAV antibodies was found in hemophilia patients born in the 1950s using cryoprecipitate (11%) as compared to blood donors of the same age (40%), probably caused by passive administration of anti-HAV through clotting product. Passive immunization in the past was significantly (p <0.02) more often found in group 2 (41.7%) than in group 1 (28%).In the period 1983 till 1988 five seroconversions were seen in group 1 (2%) and one in group 2 (0.7%). Anti-HAV seroconversions were not observed after 1988.In a risk analysis we estimated that 2 plasma pools of 10,000 Dutch blood donors per year may contain HAV. The absence of HAV among Dutch hemophilia patients suggests that this contamination is successfully inactivated.
Collapse
Affiliation(s)
| | - H L Zaaijer
- The Department of Viral Serology, Central Laboratory of The Netherlands Red Cross Blood Transfusion Service, Amsterdam, The Netherlands
| | | | - H M van den Berg
- The Van Creveld Clinic, University Hospital Utrecht, The Netherlands
- The Wilhelmina Childrens Hospital, Utrecht, The Netherlands
| | - G Roosendaal
- The Van Creveld Clinic, University Hospital Utrecht, The Netherlands
| | - P N Lelie
- The Department of Viral Serology, Central Laboratory of The Netherlands Red Cross Blood Transfusion Service, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Atiq F, Meijer K, Eikenboom J, Fijnvandraat K, Mauser-Bunschoten EP, van Galen KPM, Nijziel MR, Ypma PF, de Meris J, Laros-van Gorkom BAP, van der Bom JG, de Maat MP, Cnossen MH, Leebeek FWG. Comorbidities associated with higher von Willebrand factor (VWF) levels may explain the age-related increase of VWF in von Willebrand disease. Br J Haematol 2018; 182:93-105. [PMID: 29767844 PMCID: PMC6032952 DOI: 10.1111/bjh.15277] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/26/2018] [Indexed: 02/04/2023]
Abstract
Some comorbidities, such as hypertension, are associated with higher von Willebrand factor (VWF) levels in the general population. No studies have been conducted to assess this association in patients with von Willebrand disease (VWD). Therefore, we studied this association in patients with type 1 (n = 333) and type 2 (n = 203) VWD from the 'WiN" study. VWF antigen (VWF:Ag) was higher in type 1 VWD patients with hypertension [difference: 0·23 iu/ml, 95% confidence interval (CI): 0·11-0·35], diabetes mellitus (0·11 iu/ml, 95% CI: -0·02 to 0·23), cancer (0·14 iu/ml, 95% CI: 0·03-0·25) and thyroid dysfunction (0·14 iu/ml, 95% CI: 0·03-0·26) than in patients without these comorbidities (all corrected for age, sex and blood group). Similar results were observed for VWF collagen binding capacity (VWF:CB), VWF activity as measured by the VWF monoclonal antibody assay (VWF:Ab) and factor VIII (FVIII) coagulant activity (FVIII:C). In type 1 VWD, age was associated with higher VWF:Ag (0·03 iu/ml; 95% CI: 0·01-0·04), VWF:CB (0·02 iu/ml; 95% CI: 0·00-0·04), VWF:Ab (0·04 iu/ml; 95% CI: 0·02-0·06) and FVIII:C (0·03 iu/ml; 95% CI: 0·01-0·06) per decade increase. After adjustment for relevant comorbidities, these associations were no longer significant. Despite the higher VWF and FVIII levels, type 1 VWD patients with comorbidities had more bleeding episodes, particularly during surgery. There was no association between comorbidities and VWF/FVIII levels or bleeding phenotype in type 2 VWD patients. In conclusion, comorbidities are associated with higher VWF and FVIII levels in type 1 VWD and may explain the age-related increase of VWF and FVIII levels.
Collapse
Affiliation(s)
- Ferdows Atiq
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Karina Meijer
- Department of Haematology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Jeroen Eikenboom
- Department of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, the Netherlands
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Centre, Leiden, the Netherlands
| | - Karin Fijnvandraat
- Pediatric Haematology, Emma Children's Hospital-Academic Medical Centre, Amsterdam, the Netherlands
| | | | - Karin P M van Galen
- Van Creveldkliniek, University Medical Centre University Utrecht, Utrecht, the Netherlands
| | - Marten R Nijziel
- Department of Haematology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Haematology, Catharina Hospital, Eindhoven, the Netherlands
| | - Paula F Ypma
- Department of Haematology, Haga Hospital, The Hague, the Netherlands
| | - Joke de Meris
- Netherlands Haemophilia Society, Leiden, the Netherlands
| | | | - Johanna G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
- Jon J van Rood Centre for Clinical Transfusion Medicine, Sanquin Research, Leiden, the Netherlands
| | - Moniek P de Maat
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Haematology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Frank W G Leebeek
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| |
Collapse
|
10
|
de Wee EM, Sanders YV, Mauser-Bunschoten EP, van der Bom JG, Degenaar-Dujardin MEL, Eikenboom J, de Goede-Bolder A, Laros-van Gorkom BAP, Meijer K, Hamulyák K, Nijziel MR, Fijnvandraat K, Leebeek FWG. Determinants of bleeding phenotype in adult patients with moderate or severe von Willebrand disease. Thromb Haemost 2017; 108:683-92. [DOI: 10.1160/th12-04-0244] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 07/18/2012] [Indexed: 12/28/2022]
Abstract
SummaryWe performed a nation-wide cross-sectional study to evaluate determinants of bleeding symptoms in a large unselected cohort of adults with von Willebrand disease (VWD). VWD patients were included (n=664), based on lowest historically measured VWF:Ag and VWF:Act levels ≤30 U/dl. Menorrhagia (85%), cutaneous bleeding (77%), bleeding from minor wounds (77%) and oral-cavity bleeding (62%) occurred most frequently. Higher age was associated with a higher bleeding score (BS), determined according to Tosetto, in females. A 10 year increase in age was associated with 0.8 point (95% confidence interval [CI] 0.4–1.1) higher BS. Females had higher BS than males (median 12 vs. 10, p=0.012). BS differed significantly between VWD type 1, 2 and 3: median 9 (-2–31), 13 (-1–33) and 19.5 (1–35), respectively (p<0.001). BS was strongly associated with VWF and FVIII levels: individuals with VWF:Ag levels ≤10 IU/dl, VWF:Act ≤10 IU/dl and FVIII:C ≤10 IU/dl had, respectively, 5.3 point (95%CI 3.2–7.3), 4.3 point (95%CI 2.9–5.8) and 9.6 point (95%CI 6.5–12.7) higher BS, than those with levels >30 IU/dl. In type 3 patients 1 IU/dl FVIII:C decrease was associated with 0.6 point (95% CI 0.1–1.1) BS increase (p=0.021). In conclusion, in VWD patients the bleeding phenotype is strongly associated with type of VWD and VWF and FVIII levels.
Collapse
|
11
|
van de Putte DE, Fischer K, Makris M, Tait R, Collins PW, Meijer K, Roosendaal G, Chowdary P, Schutgens REG, Mauser-Bunschoten EP. Increased prevalence of hypertension in haemophilia patients. Thromb Haemost 2017; 108:750-5. [DOI: 10.1160/th12-05-0313] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 08/04/2012] [Indexed: 11/05/2022]
Abstract
SummaryAn increased prevalence of hypertension is reported in haemophilia patients, but data from large, unbiased studies are lacking. The aim of our study was to cross-sectionally assess the prevalence of hypertension in a large cohort of 701 haemophilia patients. Blood pressure (BP) measurements performed in 386 Dutch and 315 UK haemophilia patients aged 30 years or older were analysed and compared with the general age-matched male population. Mean values of up to three BP measurements were used when available. Hypertension was defined as BP over 140/90 mmHg and/or the use of antihypertensive medication. A total of 49% of patients had severe haemophilia. Mean age was 49.8 years. The prevalence of hypertension was significantly higher in haemophilia patients (49%, 95% confidence interval [CI] 45–53) than in the general population (40%, 95% CI 37–43). The prevalence of hypertension was higher in patients with severe haemophilia than in those with non-severe disease, but similar across haemophilia types and in Dutch and UK patients. Multiple BP measurements were available for 70%.The prevalence of hypertension was similar in patients with multiple BP measurements and the complete cohort. Hypertension was not significantly associated with renal function, a history of renal bleeding or with infection with hepatitis C or HIV, but it was associated with overweight/obesity and age. In conclusion, the prevalence of hypertension is higher in haemophilia patients than in the general population. The cause of this increased prevalence is unknown. Blood pressure measurements should be part of standard care in haemophilia patients aged 30 years or older.
Collapse
|
12
|
Fischer K, Makris M, Tait CR, Chowdary P, Collins PW, Meijer K, Roosendaal G, Schutgens REG, Mauser-Bunschoten EP, Fransen van de Putte DE. Unfavourable cardiovascular disease risk profiles in a cohort of Dutch and British haemophilia patients. Thromb Haemost 2017; 109:16-23. [DOI: 10.1160/th12-05-0332] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 09/17/2012] [Indexed: 11/05/2022]
Abstract
SummaryCardiovascular disease (CVD) mortality is reported to be decreased in haemophilia patients, but reports on the prevalence of CVD risk factors are conflicting. A cross-sectional assessment of CVD risk profiles was performed in a large cohort of haemophilia patients. Baseline data on CVD risk factors of 709 Dutch and UK haemophilia patients aged ≥ 30 years were analysed and compared with the general age-matched male population. CVD risk profiles were assessed using the QRISK®2–2011 and SCORE algorithms. Although QRISK®2 was only validated in the UK, comparison with SCORE indicated similar properties of QRISK®2 in both Dutch and UK patients (correlation 0.86). Mean age was 49.8 years. Hypertension was more common in haemophilia patients than in the general population (49% vs. 40%), while the prevalences of obesity and hypercholesterolaemia were lower (15 vs. 20% and 44 vs. 68%, respectively), and those of diabetes and smoking were similar. The predicted 10-year QRISK®2 risk was significantly higher in haemophilia patients than in the general population (8.9 vs. 6.7%), indicating more unfavourable cardiovascular disease risk profiles. This increased risk became apparent after the age of 40 years. Our results indicate an increased prevalence of hypertension and overall more unfavourable CVD risk profiles in haemophilia patients compared with the general age-matched male population.
Collapse
|
13
|
van Galen KPM, de Kleijn P, Foppen W, Eikenboom J, Meijer K, Schutgens REG, Fischer K, Cnossen MH, de Meris J, Fijnvandraat K, van der Bom JG, Laros-van Gorkom BAP, Leebeek FWG, Mauser-Bunschoten EP. Long-term impact of joint bleeds in von Willebrand disease: a nested case-control study. Haematologica 2017; 102:1486-1493. [PMID: 28572165 PMCID: PMC5685243 DOI: 10.3324/haematol.2017.168617] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/30/2017] [Indexed: 11/11/2022] Open
Abstract
Patients with severe von Willebrand disease (VWD) may develop arthropathy after joint bleeds. Information on its prevalence and severity is limited. We aimed to assess the occurrence and severity of arthropathy in VWD and its impact on daily life. VWD patients with and without verified joint bleeds were matched for age, sex and Factor VIII level or von Willebrand Factor activity in a nested case-control study within the Willebrand in the Netherlands study. Assessments included the Hemophilia Joint Health Score (0–124), Pettersson score (0–13 per joint X-ray), Hemophilia Activity List score (0–100), joint pain (Visual Analog Scale 0–10), and the Impact on Participation and Autonomy questionnaire (0–20). Arthropathy was defined as a Hemophilia Joint Health Score of 10 or higher, or a Pettersson score over 3 of at least one joint. We included 48 patients with verified joint bleeds (cases) and 48 controls: 60% males, mean age 46 years (range 18–80), median von Willebrand Factor activity 5 versus 8 IU/dL and Factor VIII 24 versus 36 IU/dL. Arthropathy occurred in 40% of the cases versus 10% of the controls (P<0.01). The cases reported more functional limitations compared to the controls (median Hemophilia Activity List score: 88 vs. 100, P<0.01). Arthropathy was related to joint pain and less social participation (Visual Analog Scale>3: 13 of 19 vs. 3 of 28, P<0.01, and median score on the participation questionnaire 6.1 vs. 0.9, P<0.01). In conclusion, arthropathy occurs in 40% of VWD patients after joint bleeds and is associated with pain, radiological abnormalities, functional limitations, and less social participation (Dutch trial register: NTR4548).
Collapse
Affiliation(s)
| | - Piet de Kleijn
- Van Creveldkliniek and Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Centre Utrecht, the Netherlands
| | - Wouter Foppen
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Jeroen Eikenboom
- Department of Thrombosis and Hemostasis and Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, the Netherlands
| | - Karina Meijer
- Department of Hematology, University of Groningen, University Medical Center Groningen, the Netherlands
| | | | - Kathelijn Fischer
- Van Creveldkliniek and Julius Center Department of Epidemiology, University Medical Center Utrecht, the Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Hematology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Joke de Meris
- Dutch Society of Haemophilia Patients, Leiden, the Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Academisch Medisch Centrum, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Johanna G van der Bom
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin Research, Leiden, and Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands
| | | | - Frank W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | |
Collapse
|
14
|
Nijdam A, Foppen W, van der Schouw YT, Mauser-Bunschoten EP, Schutgens REG, Fischer K. Long-term effects of joint bleeding before starting prophylaxis in severe haemophilia. Haemophilia 2016; 22:852-858. [PMID: 27396935 DOI: 10.1111/hae.12959] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Early initiation of prophylaxis in severe haemophilia is critical for effective prevention of arthropathy. However, the optimum time for starting prophylaxis has not been established yet. AIM This study assessed long-term effects of age at starting prophylaxis and joint bleeding before prophylaxis on haemophilic arthropathy. METHODS In patients with severe haemophilia (FVIII/IX <0.01 IU mL-1 ), born between 1965 and 2000, haemophilic arthropathy was evaluated on X-rays. Patient groups were compared by multivariable regression analysis, adjusted for bleeding phenotype and lifetime intensity of prophylaxis. RESULTS One hundred and twenty-four patients were evaluated at a median age of 22 years. When comparing patients according to age at starting prophylaxis, starting before age 6 years was significantly better than starting later (P < 0.01), but no additional benefit of starting before age 3 years was demonstrated. The number of joint bleeds before prophylaxis had a stronger association with arthropathy than age at starting prophylaxis. Starting prophylaxis before the onset of joint bleeding resulted in the best long-term outcome (P ≤ 0.02); starting after one joint bleed appeared to have acceptable long-term outcome. The difference between starting after 0-1 and 2-5 joint bleeds was notable, but statistical significance was not reached (P = 0.15). CONCLUSION Future research with more patients on early prophylaxis will have to clarify whether starting prophylaxis before joint bleeding is superior.
Collapse
Affiliation(s)
- A Nijdam
- Van Creveldkliniek, Center for Benign Hematology, Thrombosis and Hemostasis, University Medical Center, Utrecht, The Netherlands
| | - W Foppen
- Department of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Y T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - E P Mauser-Bunschoten
- Van Creveldkliniek, Center for Benign Hematology, Thrombosis and Hemostasis, University Medical Center, Utrecht, The Netherlands
| | - R E G Schutgens
- Van Creveldkliniek, Center for Benign Hematology, Thrombosis and Hemostasis, University Medical Center, Utrecht, The Netherlands
| | - K Fischer
- Van Creveldkliniek, Center for Benign Hematology, Thrombosis and Hemostasis, University Medical Center, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| |
Collapse
|
15
|
Eckhardt CL, Loomans JI, van Velzen AS, Peters M, Mauser-Bunschoten EP, Schwaab R, Mazzucconi MG, Tagliaferri A, Siegmund B, Reitter-Pfoertner SE, van der Bom JG, Fijnvandraat K. Inhibitor development and mortality in non-severe hemophilia A. J Thromb Haemost 2015; 13:1217-25. [PMID: 25912309 DOI: 10.1111/jth.12990] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/24/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The life expectancy of non-severe hemophilia A (HA) patients equals the life expectancy of the non-hemophilic population. However, data on the effect of inhibitor development on mortality and on hemophilia-related causes of death are scarce. The development of neutralizing factor VIII antibodies in non-severe HA patients may dramatically change their clinical outcome due to severe bleeding complications. OBJECTIVES We assessed the association between the occurrence of inhibitors and mortality in patients with non-severe HA. METHODS In this retrospective cohort study, clinical data and vital status were collected for 2709 non-severe HA patients (107 with inhibitors) who were treated between 1980 and 2011 in 34 European and Australian centers. Mortality rates for patients with and without inhibitors were compared. RESULTS During 64,200 patient-years of follow-up, 148 patients died (mortality rate, 2.30 per 1000 person-years; 95% confidence interval (CI), 1.96-2.70) at a median age of 64 years (interquartile range [IQR], 49-76). In 62 patients (42%) the cause of death was hemophilia related. Sixteen inhibitor patients died at a median age of 71 years (IQR, 60-81). In ten patients the inhibitor was present at time of death; seven of them died of severe bleeding complications. The all-cause mortality rate in inhibitor patients was > 5 times increased compared with that for those without inhibitors (age-adjusted mortality rate ratio, 5.6). CONCLUSION Inhibitor development in non-severe hemophilia is associated with increased mortality. High rates of hemophilia-related mortality in this study indicate that non-severe hemophilia is not mild at all and stress the importance of close follow-up for these patients.
Collapse
Affiliation(s)
- C L Eckhardt
- Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - J I Loomans
- Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - A S van Velzen
- Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - M Peters
- Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - E P Mauser-Bunschoten
- Department of Hematology, van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R Schwaab
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
| | - M G Mazzucconi
- Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
| | - A Tagliaferri
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital, Parma, Italy
| | - B Siegmund
- Institute for Thrombophilia and Haemostaseology, Raphaelsklinik, Munster, Germany
| | - S E Reitter-Pfoertner
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - J G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Jon J. van Rood Center for Clinical Transfusion Research, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - K Fijnvandraat
- Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
16
|
Sanders YV, van der Bom JG, Isaacs A, Cnossen MH, de Maat MPM, Laros-van Gorkom BAP, Fijnvandraat K, Meijer K, van Duijn CM, Mauser-Bunschoten EP, Eikenboom J, Leebeek FWG. CLEC4M and STXBP5 gene variations contribute to von Willebrand factor level variation in von Willebrand disease. J Thromb Haemost 2015; 13:956-66. [PMID: 25832887 DOI: 10.1111/jth.12927] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND von Willebrand factor (VWF) levels in healthy individuals are influenced by variations in genetic loci other than the VWF gene, whose contribution to VWF levels in patients with von Willebrand disease (VWD) is largely unknown. OBJECTIVES To investigate the association between single-nucleotide polymorphisms (SNPs), VWF levels, and bleeding phenotype. PATIENTS/METHODS In 364 type 1 VWD and 240 type 2 VWD patients from the nationwide cross-sectional 'Willebrand in The Netherlands' (WiN) study, we studied the association between eight SNPs in STXBP5, SCARA5, ABO, VWF, STAB2, STX2, TC2N, and CLEC4M, and VWF antigen (VWF:Ag), VWF activity (VWF:Act), and bleeding phenotype as assessed with the Tosetto bleeding score. RESULTS In type 1 patients, STXBP5 was associated with a lower VWF:Ag level (adjusted difference of -3.0 IU dL(-1) per allele; 95% confidence interval [CI] -6.0 to 0.1) and CLEC4M with both a lower VWF:Ag level (-4.3 IU dL(-1) per allele; 95% CI -7.9 to -0.6) and lower VWF:Act (-5.7 IU dL(-1) per allele; 95% CI -10.9 to -0.5). In type 2 patients, none of the SNPs was associated with VWF levels. None of the genetic variants was associated with bleeding score. CONCLUSIONS Genetic variations in STXBP5 and CLEC4M are associated with VWF level variation in type 1 VWD, but not in type 2 VWD. This study increases our understanding of the pathophysiology of VWD, and provides a further indication of the involvement of STXBP5 and CLEC4M in determining VWF levels in VWD.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biomarkers/blood
- Blood Coagulation/genetics
- Blood Coagulation Tests
- Cell Adhesion Molecules/genetics
- Child
- Child, Preschool
- Cross-Sectional Studies
- Female
- Gene Frequency
- Genetic Association Studies
- Genetic Predisposition to Disease
- Hemorrhage/blood
- Hemorrhage/genetics
- Humans
- Infant
- Lectins, C-Type/genetics
- Male
- Middle Aged
- Molecular Diagnostic Techniques
- Nerve Tissue Proteins/genetics
- Netherlands
- Phenotype
- Polymorphism, Single Nucleotide
- R-SNARE Proteins/genetics
- Receptors, Cell Surface/genetics
- Risk Factors
- Young Adult
- von Willebrand Disease, Type 1/blood
- von Willebrand Disease, Type 1/diagnosis
- von Willebrand Disease, Type 1/genetics
- von Willebrand Disease, Type 2/blood
- von Willebrand Disease, Type 2/diagnosis
- von Willebrand Disease, Type 2/genetics
- von Willebrand Factor/analysis
Collapse
Affiliation(s)
- Y V Sanders
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Jon J. van Rood Center for Clinical Transfusion Medicine, Sanquin Research, Leiden, The Netherlands
| | - A Isaacs
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M H Cnossen
- Department of Pediatric Hematology, Erasmus University Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M P M de Maat
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - K Fijnvandraat
- Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - K Meijer
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C M van Duijn
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E P Mauser-Bunschoten
- van Creveldkliniek/Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Eikenboom
- Department of Thrombosis and Hemostasis, Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - F W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
17
|
van Galen KPM, Sanders YV, Vojinovic U, Eikenboom J, Cnossen MH, Schutgens REG, van der Bom JG, Fijnvandraat K, Laros-Van Gorkom BAP, Meijer K, Leebeek FWG, Mauser-Bunschoten EP. Joint bleeds in von Willebrand disease patients have significant impact on quality of life and joint integrity: a cross-sectional study. Haemophilia 2015; 21:e185-e192. [PMID: 25854528 DOI: 10.1111/hae.12670] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Joint bleeds (JB) are reported in a minority of patients with von Willebrand disease (VWD) but may lead to structural joint damage. Prevalence, severity and impact of JB in VWD are largely unknown. OBJECTIVES The aim of this study was to assess JB prevalence, onset, treatment and impact on health-related quality of life (HR-QoL) and joint integrity in moderate and severe VWD. METHODS In the Willebrand in the Netherlands study 804 moderate and severe VWD patients [von Willebrand factor (VWF) activity ≤30U dL(-1)] completed a questionnaire on occurrence, sites and consequences of JB. To analyse JB number, onset, treatment and impact on joint integrity we additionally performed a patient-control study on medical file data comparing patients with JB to age, gender, factor VIII (FVIII)- and VWF activity matched VWD patients without JB. RESULTS Of all VWD patients 23% (184/804) self-reported JB. These 184 patients reported joint damage more often (54% vs. 18%, P < 0.001) and had lower HR-QoL (SF36, P < 0.05) compared to VWD patients not reporting JB. Of 55 patients with available JB data, 65% had the first JB before age 16. These 55 patients used more clotting factor concentrate (CFC; median dose 43 vs. 0 IE FVIII kg(-1) year(-1) , P < 0.001), more often had X-ray joint damage (44% vs. 11%, P = 0.001] and chronic joint pain (44% vs. 18%, P = 0.008) compared to 55 control VWD patients without JB. CONCLUSION In conclusion, joint bleeds are reported by 23% of moderate and severe VWD patients, mostly start in childhood, are associated with more CFC use, joint pain, lower HR-QoL and significantly more radiological and self-reported joint damage.
Collapse
Affiliation(s)
- K P M van Galen
- Department of Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
All-oral treatments of hepatitis C (HCV) have been trialled in patients with hereditary bleeding disorders and found to be effective. Further refinements of dosing and duration are being established. Importantly for patient acceptability these regimens are interferon-free. Cohort studies in older patients with haemophilia direct the need for attention to weight control, exercice, assessment of cardiovascular risk, especially hypertension and detection of osteoporosis. Where patients live a long way from a comprehensive care centre, telemedicine connections can engage centre experts with the patient and his/her local practitioners in devising and monitoring care plans.
Collapse
Affiliation(s)
- R Kulkarni
- Professor and Director Pediatric Hematology/Oncology, Michigan State University, East Lansing, MI, USA
| | | | | | | |
Collapse
|
19
|
Sanders YV, Giezenaar MA, Laros-van Gorkom BAP, Meijer K, van der Bom JG, Cnossen MH, Nijziel MR, Ypma PF, Fijnvandraat K, Eikenboom J, Mauser-Bunschoten EP, Leebeek FWG. von Willebrand disease and aging: an evolving phenotype. J Thromb Haemost 2014; 12:1066-75. [PMID: 24750783 DOI: 10.1111/jth.12586] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/14/2014] [Indexed: 11/27/2022]
Abstract
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(-1) 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, age-related 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(-1) (95% CI, -0.6 to 7.6) VWF:Ag increase and 7.1 U dL(-1) (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.
Collapse
Affiliation(s)
- Y V Sanders
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Mauser-Bunschoten EP, Fransen van de Putte DE, Ploos van Amstel HK, Spoor M, Schutgens REG. Response to desmopressin in patients with mild hemophilia A caused by the F8 c.1910A>G, p.Asn637Ser mutation. J Thromb Haemost 2013; 11:2179-81. [PMID: 24134483 DOI: 10.1111/jth.12430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Indexed: 11/30/2022]
Affiliation(s)
- E P Mauser-Bunschoten
- Department of Hematology, Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | | |
Collapse
|
21
|
Affiliation(s)
- E P Mauser-Bunschoten
- Van Creveldkliniek, Department of Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | |
Collapse
|
22
|
Sanders YV, Eikenboom J, de Wee EM, van der Bom JG, Cnossen MH, Degenaar-Dujardin MEL, Fijnvandraat K, Kamphuisen PW, Laros-van Gorkom BAP, Meijer K, Mauser-Bunschoten EP, Leebeek FWG. Reduced prevalence of arterial thrombosis in von Willebrand disease. J Thromb Haemost 2013; 11:845-54. [PMID: 23506463 DOI: 10.1111/jth.12194] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 03/07/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND High von Willebrand factor (VWF) levels are an established risk factor for arterial thrombosis, including coronary heart disease and ischemic stroke. It has been hypothesized that von Willebrand disease (VWD) patients are protected against arterial thrombosis; however, this has never been confirmed in clinical studies. OBJECTIVES To investigate the prevalence of arterial thrombosis in VWD patients relative to the general population. PATIENTS/METHODS We included 635 adult patients with VWF levels ≤ 30 U dL(-1) , aged 16-85 years, from the nationwide cross-sectional 'Willebrand in the Netherlands' (WiN) study and compared the prevalence of arterial thrombosis with two reference populations from the general Dutch population adjusted for age and sex as standardized morbidity ratios (SMRs). RESULTS Twenty-nine arterial thrombotic events occurred in 21 patients (3.3%). Five patients suffered an acute myocardial infarction and three an ischemic stroke. Unstable angina pectoris was recorded 12 times, transient ischemic attack nine. The prevalence of all arterial thrombotic events combined (acute myocardial infarction, ischemic stroke and coronary heart disease) was 39% and 63% lower than in the two reference populations. The prevalence of cardiovascular disease in VWD was lower than in the general population, SMR 0.60 (95% CI, 0.32-0.98) for coronary heart disease and SMR 0.40 (95% CI, 0.13-0.83) for acute myocardial infarction. For ischemic stroke the prevalence was 35-67% lower compared with two reference populations, SMR 0.65 (95% CI, 0.12-1.59) and 0.33 (95% CI, 0.06-0.80), respectively. CONCLUSIONS This is the first study showing that VWD patients have a reduced prevalence of arterial thrombosis and provides important insights into the role of VWF in the pathogenesis of arterial thrombosis.
Collapse
Affiliation(s)
- Y V Sanders
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Schutgens REG, Tuinenburg A, Fischer K, Mauser-Bunschoten EP. Anticoagulation therapy in haemophilia. Managing the unknown. Hamostaseologie 2013; 33:299-304. [PMID: 23446851 DOI: 10.5482/hamo-12-08-0015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 02/06/2013] [Indexed: 01/28/2023] Open
Abstract
Patients with haemophilia (PWH) are relatively protected from cardiovascular death. Recent insights have shown that this is not due to less formation of atherosclerosis than in non-haemophilic men, therefore protection from the final occlusive thrombus will be the major determinant. Prevalence and incidence rates of cardiovascular disease (especially non-fatal events) are scarce, although ongoing studies are addressing this issue. Meanwhile, because the haemophilia population is aging, we are increasingly confronted with cardiovascular events. The main cardiovascular risk factors that should be part of regular screening programs are hypertension, overweight, lipometabolic disorders and smoking. Anticoagulation therapy in haemophilia is feasible, provided that individual tailored coagulation therapy and close monitoring is provided. Here, we present our view on anticoagulation management in PWH. There is an absolute need for risk assessment tools and prospective validation of suggested anticoagulation management strategies in PWH. Until then, we are managing the unknown.
Collapse
Affiliation(s)
- R E G Schutgens
- Roger EG Schutgens, MD, PhD, University Medical Center Utrecht, Van Creveldkliniek/Department of Haematology, Room C01.425, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands, Tel. +31/88/755 55 55, Fax +31/88/755 54 38, E-mail:
| | | | | | | |
Collapse
|
24
|
Fransen van de Putte DE, Fischer K, Makris M, Tait RC, Chowdary P, Collins PW, Meijer K, Roosendaal G, Schutgens REG, Mauser-Bunschoten EP. History of non-fatal cardiovascular disease in a cohort of Dutch and British patients with haemophilia. Eur J Haematol 2012; 89:336-9. [DOI: 10.1111/j.1600-0609.2012.01835.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2012] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Michael Makris
- Sheffield Haemophilia and Thrombosis Centre; Royal Hallamshire Hospital; Sheffield; UK
| | - R. Campbell Tait
- West of Scotland Haemophilia and Thrombosis Centre; Royal Infirmary; Glasgow; UK
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit; Royal Free Hospital; London; UK
| | - Peter W. Collins
- Arthur Bloom Haemophilia Centre, School of Medicine; Cardiff University and University Hospital of Wales; Cardiff; UK
| | - Karina Meijer
- Division of Haemostasis and Thrombosis, Department of Haematology; University Medical Center Groningen; Groningen; The Netherlands
| | - Goris Roosendaal
- Van Creveldkliniek, Department of Haematology; University Medical Center Utrecht; Utrecht; The Netherlands
| | - Roger E. G. Schutgens
- Van Creveldkliniek, Department of Haematology; University Medical Center Utrecht; Utrecht; The Netherlands
| | | |
Collapse
|
25
|
Fransen van de Putte DE, Fischer K, Pulles AE, Roosendaal G, Biesma DH, Schutgens RE, Mauser-Bunschoten EP. Non-fatal cardiovascular disease, malignancies, and other co-morbidity in adult haemophilia patients. Thromb Res 2012; 130:157-62. [DOI: 10.1016/j.thromres.2011.12.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 12/02/2011] [Accepted: 12/06/2011] [Indexed: 10/14/2022]
|
26
|
Tuinenburg A, Rutten A, Kavousi M, Leebeek FW, Ypma PF, Laros-van Gorkom BA, Nijziel MR, Kamphuisen PW, Mauser-Bunschoten EP, Roosendaal G, Biesma DH, van der Lugt A, Hofman A, Witteman JC, Bots ML, Schutgens RE. Coronary Artery Calcification in Hemophilia A. Arterioscler Thromb Vasc Biol 2012; 32:799-804. [DOI: 10.1161/atvbaha.111.238162] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Ischemic heart disease mortality is lower in hemophilia patients than in the general male population. As coagulation plays a role in the inflammatory pathways involved in atherogenesis, we investigated whether the clotting factor deficiency protects hemophilia patients from developing atherosclerosis.
Methods and Results—
Coronary artery calcification, measured with multidetector-row computed tomography, was compared between 42 men, ≥59 years, with severe or moderate hemophilia A, and 613 nonhemophilic men from the Rotterdam Study, a prospective population-based study. None of the study subjects were HIV infected or had a history of cardiovascular disease. Coronary artery calcification was quantified by calculating the Agatston score and calcification mass. Data were analyzed using linear regression. Mean difference (β) of the natural log–transformed Agatston score between men with and without hemophilia was 0.141 (95% CI −0.602 to 0.885,
P
=0.709). Results did not change after adjustment for age, body mass index, hypercholesterolemia, hypertension, and use of antidiabetic medication (β=0.525, 95% CI −0.202 to 1.252,
P
=0.157). Comparable results were found for calcification mass.
Conclusion—
The extent of coronary artery atherosclerosis is comparable between elderly men with and without hemophilia. Results from this study underline the importance of screening and treating atherosclerosis risk factors in hemophilia patients.
Collapse
Affiliation(s)
- Attie Tuinenburg
- From the Van Creveldkliniek/Department of Hematology (A.T., E.P.M.-B., G.R., D.H.B., R.E.G.S.), Department of Radiology (A.R.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.R.); Departments of Epidemiology (M.K., A.H., J.C.M.W.), Hematology (F.W.G.L.) and Radiology (A.y.d.L.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department
| | - Annemarieke Rutten
- From the Van Creveldkliniek/Department of Hematology (A.T., E.P.M.-B., G.R., D.H.B., R.E.G.S.), Department of Radiology (A.R.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.R.); Departments of Epidemiology (M.K., A.H., J.C.M.W.), Hematology (F.W.G.L.) and Radiology (A.y.d.L.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department
| | - Maryam Kavousi
- From the Van Creveldkliniek/Department of Hematology (A.T., E.P.M.-B., G.R., D.H.B., R.E.G.S.), Department of Radiology (A.R.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.R.); Departments of Epidemiology (M.K., A.H., J.C.M.W.), Hematology (F.W.G.L.) and Radiology (A.y.d.L.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department
| | - Frank W.G. Leebeek
- From the Van Creveldkliniek/Department of Hematology (A.T., E.P.M.-B., G.R., D.H.B., R.E.G.S.), Department of Radiology (A.R.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.R.); Departments of Epidemiology (M.K., A.H., J.C.M.W.), Hematology (F.W.G.L.) and Radiology (A.y.d.L.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department
| | - Paula F. Ypma
- From the Van Creveldkliniek/Department of Hematology (A.T., E.P.M.-B., G.R., D.H.B., R.E.G.S.), Department of Radiology (A.R.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.R.); Departments of Epidemiology (M.K., A.H., J.C.M.W.), Hematology (F.W.G.L.) and Radiology (A.y.d.L.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department
| | - Britta A.P. Laros-van Gorkom
- From the Van Creveldkliniek/Department of Hematology (A.T., E.P.M.-B., G.R., D.H.B., R.E.G.S.), Department of Radiology (A.R.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.R.); Departments of Epidemiology (M.K., A.H., J.C.M.W.), Hematology (F.W.G.L.) and Radiology (A.y.d.L.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department
| | - Marten R. Nijziel
- From the Van Creveldkliniek/Department of Hematology (A.T., E.P.M.-B., G.R., D.H.B., R.E.G.S.), Department of Radiology (A.R.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.R.); Departments of Epidemiology (M.K., A.H., J.C.M.W.), Hematology (F.W.G.L.) and Radiology (A.y.d.L.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department
| | - Pieter W. Kamphuisen
- From the Van Creveldkliniek/Department of Hematology (A.T., E.P.M.-B., G.R., D.H.B., R.E.G.S.), Department of Radiology (A.R.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.R.); Departments of Epidemiology (M.K., A.H., J.C.M.W.), Hematology (F.W.G.L.) and Radiology (A.y.d.L.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department
| | - Eveline P. Mauser-Bunschoten
- From the Van Creveldkliniek/Department of Hematology (A.T., E.P.M.-B., G.R., D.H.B., R.E.G.S.), Department of Radiology (A.R.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.R.); Departments of Epidemiology (M.K., A.H., J.C.M.W.), Hematology (F.W.G.L.) and Radiology (A.y.d.L.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department
| | - Goris Roosendaal
- From the Van Creveldkliniek/Department of Hematology (A.T., E.P.M.-B., G.R., D.H.B., R.E.G.S.), Department of Radiology (A.R.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.R.); Departments of Epidemiology (M.K., A.H., J.C.M.W.), Hematology (F.W.G.L.) and Radiology (A.y.d.L.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department
| | - Douwe H. Biesma
- From the Van Creveldkliniek/Department of Hematology (A.T., E.P.M.-B., G.R., D.H.B., R.E.G.S.), Department of Radiology (A.R.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.R.); Departments of Epidemiology (M.K., A.H., J.C.M.W.), Hematology (F.W.G.L.) and Radiology (A.y.d.L.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department
| | - Aad van der Lugt
- From the Van Creveldkliniek/Department of Hematology (A.T., E.P.M.-B., G.R., D.H.B., R.E.G.S.), Department of Radiology (A.R.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.R.); Departments of Epidemiology (M.K., A.H., J.C.M.W.), Hematology (F.W.G.L.) and Radiology (A.y.d.L.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department
| | - Albert Hofman
- From the Van Creveldkliniek/Department of Hematology (A.T., E.P.M.-B., G.R., D.H.B., R.E.G.S.), Department of Radiology (A.R.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.R.); Departments of Epidemiology (M.K., A.H., J.C.M.W.), Hematology (F.W.G.L.) and Radiology (A.y.d.L.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department
| | - Jacqueline C.M. Witteman
- From the Van Creveldkliniek/Department of Hematology (A.T., E.P.M.-B., G.R., D.H.B., R.E.G.S.), Department of Radiology (A.R.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.R.); Departments of Epidemiology (M.K., A.H., J.C.M.W.), Hematology (F.W.G.L.) and Radiology (A.y.d.L.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department
| | - Michiel L. Bots
- From the Van Creveldkliniek/Department of Hematology (A.T., E.P.M.-B., G.R., D.H.B., R.E.G.S.), Department of Radiology (A.R.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.R.); Departments of Epidemiology (M.K., A.H., J.C.M.W.), Hematology (F.W.G.L.) and Radiology (A.y.d.L.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department
| | - Roger E.G. Schutgens
- From the Van Creveldkliniek/Department of Hematology (A.T., E.P.M.-B., G.R., D.H.B., R.E.G.S.), Department of Radiology (A.R.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.R.); Departments of Epidemiology (M.K., A.H., J.C.M.W.), Hematology (F.W.G.L.) and Radiology (A.y.d.L.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department
| |
Collapse
|
27
|
Balak DMW, Gouw SC, Plug I, Mauser-Bunschoten EP, Vriends AHJT, Van Diemen-Homan JEM, Rosendaal FR, van der Bom JG. Prenatal diagnosis for haemophilia: a nationwide survey among female carriers in the Netherlands. Haemophilia 2012; 18:584-92. [PMID: 22250892 DOI: 10.1111/j.1365-2516.2011.02742.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Carriers of haemophilia face difficult choices regarding prenatal diagnosis, but little is known about the determinants that influence their decisions. The aim of this study was to assess the incidence of prenatal diagnosis and potential determinants affecting the choice for prenatal diagnosis. A nationwide survey was performed among all women who underwent carriership testing for haemophilia in the Netherlands between 1992 and 2004. Prenatal diagnosis was assessed in 207 carriers of haemophilia A or B who had been pregnant. Prenatal diagnosis was categorized into early first trimester (Y-PCR testing or chorionic villus sampling) often intended to prevent the birth of a child with haemophilia, and into late prenatal diagnosis (amniocentesis or ultrasound assessment) aimed at obstetrical management. Of 207 carriers 112 (54%) underwent prenatal diagnosis. Forty-eight women underwent early prenatal diagnosis and 64 women underwent late prenatal diagnosis. In 26 pregnancies early prenatal diagnosis was positive for haemophilia, and in 18 of these pregnancies termination was opted for. The choice for early prenatal diagnosis was associated with a liberal view towards termination of pregnancy (relative risk (RR) 12.5; 95% confidence interval (CI) 3.1-51.2), severe haemophilia in the family (RR 20.2; CI 2.7-153.6), absence of a religion (RR 1.9; CI 1.1-3.1) and older age (RR 2.0; CI 1.0-3.9). The choice for late prenatal diagnosis was associated with birth year after 1970 (RR 2.3; CI 1.5-3.5) and a previous child with haemophilia (RR 2.2; CI 1.4-3.4). More than half of all Dutch haemophilia carriers underwent prenatal diagnosis. Several determinants were strongly associated with prenatal diagnosis.
Collapse
Affiliation(s)
- D M W Balak
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Fransen van de Putte DE, Fischer K, de Knegt RJ, Posthouwer D, van Erpecum KJ, Biesma DH, Mauser-Bunschoten EP. Beneficial effect of successful HCV treatment in patients with inherited bleeding disorders, assessed by liver stiffness measurements. Haemophilia 2011; 18:e266-72. [PMID: 22103568 DOI: 10.1111/j.1365-2516.2011.02697.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hepatitis C infection is a major comorbidity in patients with inherited bleeding disorders. Successful antiviral treatment leads to a reduction in liver fibrosis, as shown by liver biopsies. Liver stiffness measurement (LSM) is a non-invasive method of assessing liver fibrosis. The aim of this cohort study was to evaluate the long-term effect of successful antiviral treatment, using LSM, in HCV-infected patients with inherited bleeding disorders. The LSM were performed in 2005 (LSM 1) and 2009 (LSM 2) in 39 patients who were successfully treated for HCV. The change in liver fibrosis between LSM 1 and 2 was assessed. The median duration of HCV infection was 28.8 years. A total of 22 patients (56%) underwent successful antiviral treatment before LSM 1 (group 1), and 17 patients between LSM 1 and LSM 2 (group 2). The median time since antiviral treatment was 8.8 years in group 1 and 2.5 years in group 2. In group 1, the median results of LSM 1 and 2 were similar (6.0 vs. 5.6 kPa, P-value 0.36), so overall, patients remained stable. In three patients in this group, all treated more than 15 years ago, an increase of liver stiffness was shown. Group 2 showed a significant improvement in median LSM results (10.3 vs. 6.1 kPa, P-value <0.01), with decrease of liver stiffness in 82%. Even after a long HCV infection duration, successful antiviral treatment led to a significant improvement of fibrosis, measured by LSM, mainly in the first few years after completing treatment.
Collapse
Affiliation(s)
- D E Fransen van de Putte
- Van Creveldkliniek, Department of Haematology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
29
|
Berntorp E, Keeling D, Makris M, Tagliaferri A, Male C, Mauser-Bunschoten EP, Musso R, Roca CA, Hassoun A, Kollmer C, Charnigo R, Baumann J, Rendo P. A prospective registry of European haemophilia B patients receiving nonacog alfa, recombinant human factor IX, for usual use. Haemophilia 2011; 18:503-9. [PMID: 22044794 DOI: 10.1111/j.1365-2516.2011.02685.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nonacog alfa, a recombinant factor IX (FIX) used for the treatment of haemophilia B, was approved in Europe in 1998. In accordance with European Medicines Agency requirements, a registry study was conducted from 2002 to 2009. A reformulated iso-osmotic version was approved for European use in 2007. This study was conducted to evaluate the safety of nonacog alfa in a usual care setting, and provide clinical trial and postmarketing surveillance data support. This open-label, non-interventional, prospective observational cohort study (registry) comprised 52 sites in nine European countries. Patients with haemophilia B receiving nonacog alfa in either formulation for prevention or treatment were followed on a usual care schedule. A total of 218 patients were enrolled, of whom 66 (30.3%) were <18 years of age. Haemophilia severity was evenly distributed, with baseline FIX activity of <1%, 1-5% and >5% in 33.3%, 36.6% and 30.1% of patients, respectively. One hundred thirty-eight patients received the original formulation alone; 80 switched to or received only the new formulation. There was a low incidence of events of special interest (ESIs), with less-than-expected therapeutic effect in five patients (2.2%), inhibitor development in two (0.9%), thrombosis in one (0.5%) and allergic events in eight (3.7%). These accounted for the majority of the 15 serious AEs reported in six patients. Six patients discontinued because of AEs, primarily related to hypersensitivity. Nonacog alfa was shown to be safe for the treatment of haemophilia B, with a low incidence of serious AEs and ESIs.
Collapse
Affiliation(s)
- E Berntorp
- Malmö Centre for Thrombosis and Haemostasis, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
De Wee EM, Klaij K, Eikenboom HCJ, Van Der Bom JG, Fijnvandraat K, Laros-Van Gorkom BAP, Mauser-Bunschoten EP, Meijer K, Goverde G, Van Der Linden PWG, Rijken DC, Leebeek FWG. Effect of fibrinolysis on bleeding phenotype in moderate and severe von Willebrand disease. Haemophilia 2011; 18:444-51. [PMID: 21910790 DOI: 10.1111/j.1365-2516.2011.02645.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with von Willebrand disease (VWD), the most common inherited bleeding disorder, display large variation in bleeding tendency, which is not completely related to VWF levels. The cause of variability in clinical expression is largely unknown. The effect of plasma fibrinolytic capacity on bleeding tendency in VWD patients has not been investigated. We hypothesized that enhanced fibrinolysis may result in a more severe bleeding phenotype. Therefore, we measured the fibrinolytic potential in patients with moderate or severe VWD to investigate the contribution of fibrinolysis to the bleeding tendency. Fibrinolytic potential was measured as plasma clot lysis time (CLT) with and without addition of potato carboxypeptidase inhibitor (PCI) in 638 patients with moderate or severe VWD who participated in a nationwide multicentre cross-sectional study. Bleeding severity was measured using the Bleeding Score (BS).The CLTs were significantly longer, indicative of hypofibrinolysis, in men compared to women with VWD [106.2 (IQR 95.7-118.1) vs. 101.9 (IQR 92.8-114.0) min]. The CLTs prolonged with increasing age. No association was found between VWF or FVIII levels and CLT, or between VWF or FVIII levels and CLT(+PCI) . No association was observed for BS in a model with 10log-transformed CLT, adjusted for age, gender, VWF:Act and FVIII [b = 6.5 (95%CI -0.3 to 13.4)]. Our study showed that the plasma fibrinolytic potential does not influence bleeding tendency in VWD patients and therefore does not explain the variability in bleeding phenotype in VWD.
Collapse
Affiliation(s)
- E M De Wee
- Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Fransen van de Putte DE, Fischer K, de Knegt RJ, Posthouwer D, van Erpecum KJ, Mauser-Bunschoten EP. Liver stiffness measurements to assess progression of fibrosis in HCV-infected patients with inherited bleeding disorders. Haemophilia 2011; 17:e975-80. [PMID: 21535322 DOI: 10.1111/j.1365-2516.2011.02542.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hepatitis C is a major co-morbidity in patients with inherited bleeding disorders, leading to progressive liver fibrosis and eventually cirrhosis. Liver stiffness measurement (LSM) is a non-invasive way of assessing the extent of liver fibrosis. This article describes our experience with serial LSM to assess prospectively progression of fibrosis in a cohort of patients with inherited bleeding disorders and chronic hepatitis C. A total of 84 patients underwent serial LSMs, with a median interval of 3.7 years. The change in LSM results over time was assessed. Overall, there was no significant difference between the median results of LSM 1 and LSM 2. The median result of LSM 2 was low (6.6 kPa), after a median duration of infection of 37 years. On the individual level, deterioration of LSM results of more than 2 kPa was seen in 13 patients (16%), 44 patients (52%) remained stable and 27 patients (32%) showed improvement of LSM results of more than 2 kPa. These results are comparable with those of paired liver biopsy studies. LSM appears to be a good alternative for liver biopsies in patients with hepatitis C and inherited bleeding disorders, although the interpretation of the unexpected improvement we found in some of our patients is not straightforward. LSMs will be repeated in our patient population in a few years to be able to better assess the value of serial LSM.
Collapse
Affiliation(s)
- D E Fransen van de Putte
- Van Creveldkliniek, Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
32
|
de Wee EM, Fijnvandraat K, de Goede-Bolder A, Mauser-Bunschoten EP, Eikenboom JCJ, Brons PP, Smiers FJ, Tamminga R, Oostenbrink R, Raat H, van der Bom JG, Leebeek FWG. Impact of von Willebrand disease on health-related quality of life in a pediatric population. J Thromb Haemost 2011; 9:502-9. [PMID: 21166992 DOI: 10.1111/j.1538-7836.2010.04175.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Von Willebrand disease (VWD) is the most frequent inherited bleeding disorder. Whether VWD is associated with health-related quality of life (HR-QoL) in children is unknown. OBJECTIVES This nationwide cross-sectional study measured HR-QoL in children with moderate or severe VWD. Our primary aim was to compare HR-QoL of VWD patients with that of reference populations. Additionally, we studied the impact of bleeding phenotype and VWD type on HR-QoL. METHODS HR-QoL was assessed with the Infant/Toddler QoL Questionnaire (0-5 years) and Child Health Questionnaire (6-15 years), and compared with reference population scores. Multivariate analysis was used to evaluate the influence of type of VWD and bleeding phenotype on HR-QoL scores. RESULTS Preschool children (0-5 years, n = 46) with VWD had lower HR-QoL scores for general health perceptions and parental time than reference populations. School children (6-15 years, n = 87) with VWD had lower scores for physical functioning, role functioning - emotional/behavioral, general health perceptions, and physical summary. Type of VWD was associated with HR-QoL in school children for bodily pain, general health perceptions, parental emotion, family activities, and physical summary. Scores of children with type 3 VWD were, on average, 15 points lower than those of the reference population on the above-mentioned scales. A more severe bleeding phenotype was associated with a lower score on 11/15 physical, emotional and social scales. CONCLUSION HR-QoL is lower in VWD children than in reference populations, in particular in school children. The negative impact of VWD is sensitive to type of VWD and bleeding phenotype; as well as physical scales, emotional and social scales are affected.
Collapse
Affiliation(s)
- E M de Wee
- Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
de Wee EM, Mauser-Bunschoten EP, Van Der Bom JG, Degenaar-Dujardin MEL, Eikenboom HCJ, Fijnvandraat K, de Goede-Bolder A, Laros-van Gorkom BAP, Meijer K, Raat H, Leebeek FWG. Health-related quality of life among adult patients with moderate and severe von Willebrand disease. J Thromb Haemost 2010; 8:1492-9. [PMID: 20345712 DOI: 10.1111/j.1538-7836.2010.03864.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
SUMMARY BACKGROUND von Willebrand Disease (VWD) is the most frequent inherited bleeding disorder. It is unknown how this disorder affects quality of life. OBJECTIVES This nationwide multicenter cross-sectional study determined health-related quality of life (HR-QoL) in adult patients with moderate or severe VWD, and assessed whether bleeding severity and type of VWD are associated with HR-QoL. METHODS HR-QoL was assessed using the Short Form (SF)-36, and bleeding severity was measured using the Bleeding Score (BS). RESULTS Five hundred and nine patients participated; 192 males and 317 females, median age and range 45 (16-87) and 47 (16-84) years, respectively. Compared with the general population, HR-QoL in VWD patients was lower in the vitality domain (61 vs. 66 P < 0.001 for females, 67 vs. 72 P < 0.001 for males). Patients with the most severe bleeding phenotype (highest quartile BS, BS > 17) had a lower HR-QoL in eight domains than patients with a less severe bleeding type (lowest quartile BS, BS < 7) in the univariate analysis. After adjustment for age, gender, co-morbidity and employment/educational status, a more severe bleeding phenotype was associated with lower scores on the domains of physical functioning, role limitations due to physical functioning, bodily pain, general health, social functioning and physical component summary. CONCLUSIONS HR-QoL is lower in VWD patients compared with the general population. HR-QoL is strongly associated with bleeding phenotype.
Collapse
Affiliation(s)
- E M de Wee
- Hematology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Schild FJA, Mauser-Bunschoten EP, Verbout AJ, Van Rinsum AC, Roosendaal G. Total knee arthroplasty in hemophilic arthropathy: efficiency of clotting factor usage in multijoint procedures. J Thromb Haemost 2009; 7:1741-3. [PMID: 19682237 DOI: 10.1111/j.1538-7836.2009.03569.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
35
|
Abstract
Mortality due to ischemic heart disease in hemophilia patients is lower as compared to the general male population. Differences in the prevalence of cardiovascular risk factors cannot explain this finding. The hypocoagulable state of hemophilia patients might have a protective effect on thrombus formation, which precipitates infarction. It remains unclear whether the deficiency of coagulation factor VIII or IX exerts a protective effect on the development of atherosclerosis. Despite the relative protection against cardiovascular events, the incidence of ischemic cardiovascular disease in hemophilia patients is increasing, because life expectancy of these patients now approaches that of the general population. This review focuses on what is currently known about cardiovascular risk factors, atherosclerosis, arterial thrombosis and ischemic cardiovascular disease in hemophilia patients.
Collapse
Affiliation(s)
- A Tuinenburg
- Van Creveldkliniek/Department of Haematology, University Medical Center Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|
36
|
Fransen Van De Putte DE, Fischer K, Posthouwer D, Van Erpecum K, Mauser-Bunschoten EP. Occurrence, course and risk factors of depression during antiviral treatment for chronic hepatitis C in patients with inherited bleeding disorders: a prospective study. Haemophilia 2009; 15:544-51. [PMID: 19175422 DOI: 10.1111/j.1365-2516.2008.01940.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Treatment of hepatitis C virus (HCV) consists of pegylated interferon (IFN)-alpha and ribavirin for 24 or 48 weeks. An important side-effect of IFN-alpha is depression. The occurrence, course and risk factors of depression during antiviral treatment were studied prospectively in HCV patients with inherited bleeding disorders. The Beck Depression Inventory, indicating no, mild, moderate or severe depression, was administered to 47 patients before starting therapy, after 4, 12, 24 and 48 weeks of treatment, and 4 weeks after cessation of therapy. At baseline, five patients (11%) had mild depression. Depression worsened during treatment in three of these patients. In all five patients, (mild) depression persisted 4 weeks after treatment. Of the remaining 42 patients, 23 (55%) developed depression during treatment (14 mild, eight moderate and one severe), mostly (78%) during the first 12 weeks. Four weeks after cessation of treatment, three of 23 patients still had mild depression. The only independent risk factor for development of depression was a history of depression or other psychiatric problems (odds ratio 9.7). For patients with inherited bleeding disorders, depression is a significant, mostly transient, problem during HCV treatment. We recommend close monitoring of patients, especially those with previous psychiatric problems, to ensure adequate detection and treatment of depression during antiviral therapy.
Collapse
|
37
|
Posthouwer D, Mauser-Bunschoten EP, Fischer K. Liver biopsy in patients with haemophilia; in search for a reliable, non-invasive alternative. Haemophilia 2008; 14:647-8. [PMID: 18282151 DOI: 10.1111/j.1365-2516.2008.01661.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
Mauser-Bunschoten EP, Posthouwer D, Fischer K, van den Berg HM. Safety and efficacy of a plasma-derived monoclonal purified factor VIII concentrate during 10 years of follow-up. Haemophilia 2007; 13:697-700. [PMID: 17877729 DOI: 10.1111/j.1365-2516.2007.01554.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In 1995, AAFACT, a new monoclonal purified factor VIII concentrate (FVIII), derived from human plasma, was introduced in the Netherlands. The monoclonal purification based production process includes a viral inactivation step by solvent/detergent treatment. Products manufactured according to this procedure, for example Hemofil M are used worldwide. The aim of the present study was to assess inhibitor development in a large cohort of previously treated patients (PTPs) who were followed up for 10 years. In addition, efficacy, HIV and hepatitis C virus (HCV) transmission, and allergic reactions were monitored. All 165 patients with severe haemophilia A (FVIII<1%) known at the van Creveldkliniek who ever used AAFACT during the period from October 1995 to September 2005 were included. Two of them were previously untreated patients (PUPs) and two others had <50 exposure days. Data on FVIII consumption, number of exposures, bleedings and hospitalization days were collected from start of AAFACT until last clinical and laboratory evaluation while on this product. At the end of follow-up, 91 patients were still using this plasma-derived FVIII. Median age at start of follow-up was 26 years (range 1-52). None of the patients reported lack of efficacy. Median FVIII consumption per patient during follow-up was 2058 IU kg(-1) bodyweight per year, and median number of exposures was 148 per year. During 1029 patient-years of follow-up, one inhibitor was diagnosed in a previously treated patient PTP. This patient developed high titre inhibitor following surgery for which he, during 1 week, had been treated with continuous infusion with recombinant FVIII. No inhibitor occurred during 68 cases of surgery using continuous infusion with AAFACT. No viral transmissions or other adverse events occurred during 10 years of follow-up; AAFACT appeared to be an effective and safe FVIII product.
Collapse
Affiliation(s)
- E P Mauser-Bunschoten
- Van Creveldkliniek, Division of Internal Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | | | | | | |
Collapse
|
39
|
Posthouwer D, Yee TT, Makris M, Fischer K, Griffioen A, Van Veen JJ, Mauser-Bunschoten EP. Antiviral therapy for chronic hepatitis C in patients with inherited bleeding disorders: an international, multicenter cohort study. J Thromb Haemost 2007; 5:1624-9. [PMID: 17663735 DOI: 10.1111/j.1538-7836.2007.02619.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hepatitis C is a major co-morbidity in patients with hemophilia. However, there is little information on the efficacy of antiviral therapy and long-term follow-up after treatment. OBJECTIVES To assess the effect of interferon-based (IFN-based) therapy on hepatitis C virus (HCV) eradication, to identify determinants associated with treatment response, and to assess the occurrence of end-stage liver disease (ESLD) after completing antiviral therapy. PATIENTS AND METHODS In a multicenter cohort study, 295 treatment-naïve hemophilia patients chronically infected with HCV were included. The effect of therapy was expressed as sustained virological response (SVR). Determinants associated with treatment response were expressed as odds ratios (ORs). Cumulative incidence of ESLD was assessed using a Kaplan-Meier survival table. RESULTS Among human immunodeficiency virus (HIV) negative patients (n = 235), SVR was 29% (29/101) for IFN monotherapy, 44% (32/72) for IFN with ribavirin, and 63% (39/62) for pegylated IFN (PegIFN) with ribavirin. In patients co-infected with HIV (n = 60), IFN monotherapy, IFN with ribavirin, and PegIFN with ribavirin eradicated HCV in 7/35 (20%), 1/2 (50%), and 11/23 (48%), respectively. SVR increased with genotype 2 and 3 [OR 11.0, 95% CI: 5.8-20.5], and combination therapy (IFN and ribavirin OR 3.7, 95% CI: 1.7-8.4), PegIFN and ribavirin (OR 4.2, 95% CI: 1.8-9.5). Up to 15 years after antiviral treatment, none of the patients with a SVR relapsed and none developed ESLD. In contrast, among unsuccessfully treated patients the cumulative incidence of ESLD after 15 years was 13.0%. CONCLUSIONS Successful antiviral therapy appears to have a durable effect and reduces the risk of ESLD considerably.
Collapse
Affiliation(s)
- D Posthouwer
- Van Creveldkliniek, University Medical Center, Utrecht, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
40
|
Posthouwer D, Makris M, Yee TT, Fischer K, van Veen JJ, Griffioen A, van Erpecum KJ, Mauser-Bunschoten EP. Progression to end-stage liver disease in patients with inherited bleeding disorders and hepatitis C: an international, multicenter cohort study. Blood 2007; 109:3667-71. [PMID: 17213288 DOI: 10.1182/blood-2006-08-038349] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Prior to 1990, many patients with inherited bleeding disorders were infected with hepatitis C virus (HCV). This study assessed the risk of end-stage liver disease (ESLD) in patients with hemophilia with chronic hepatitis C. Patients were infected between 1961 and 1990 and were followed up to August 2005. Of 847 anti-HCV+ patients, 160 (19%) spontaneously cleared HCV and 687 (81%) developed chronic hepatitis C. Coinfection with HIV was present in 210 patients. After 35 years of infection the cumulative incidence of ESLD was 11.5% (95% CI, 8.2%-14.8%) in HIV− patients and 35.1% (95% CI, 29.2%-41.0%; P < .001) in patients coinfected with HIV. Independent risk factors of ESLD were HIV coinfection (hazard ratio 13.8; 95% CI, 7.5-25.3), older age at infection (hazard ratio 2.3 per 10 years; 95% CI, 2.0-2.8), alcohol abuse (hazard ratio 4.9; 95% CI, 2.5-9.6), and presence of HCV genotype 1 (hazard ratio 2.2; 95% CI, 1.1-4.2). With longer duration of HCV infection, the risk of developing ESLD is emerging in patients with inherited bleeding disorders. Risk factors for rapid progression to ESLD are alcohol abuse, coinfection with HIV, older age at infection, and presence of HCV genotype 1.
Collapse
Affiliation(s)
- Dirk Posthouwer
- Van Creveldkliniek, University Medical Center Utrecht, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Posthouwer D, Mauser-Bunschoten EP, Fischer K, VAN Erpecum KJ, DE Knegt RJ. Significant liver damage in patients with bleeding disorders and chronic hepatitis C: non-invasive assessment of liver fibrosis using transient elastography. J Thromb Haemost 2007; 5:25-30. [PMID: 17239163 DOI: 10.1111/j.1538-7836.2006.02272.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Many patients with bleeding disorders have been infected with the hepatitis C virus (HCV), mainly with genotype 1. Antiviral treatment is only effective in 50% of these patients and is often accompanied by serious side effects. Consequently, careful selection of patients for treatment is warranted. Liver biopsies are generally not performed in these patients because of increased bleeding risk and high costs. We therefore assessed liver fibrosis and cirrhosis non-invasively using liver stiffness measurement (LSM). METHODS We enrolled 124 patients with bleeding disorders and chronic hepatitis C. Liver fibrosis was assessed by LSM using Fibroscan. In order to assess the validity of LSM in our hands, a separate group of 63 patients without bleeding disorders infected with HCV were evaluated with both LSM and biopsy. RESULTS In the validation study, liver elasticity was highly correlated with histological fibrosis stage (correlations coefficient 0.73, P < 0.001). Based on LSM, 18% of patients with bleeding disorders and chronic hepatitis C had severe fibrosis, and 17% had cirrhosis after 34 years of infection (range 14-40). However, the prevalence of cirrhosis based on laboratory and ultrasonographic findings was only 7%. Independent risk factors for an increase in LSM were older age at infection, higher body mass index, presence of viral co-infection, and male gender. Fifteen out of 59 patients (25%) with an apparent indication for treatment (significant fibrosis by LSM) agreed to start antiviral therapy within 3 months. CONCLUSIONS We found an unexpected high number of patients with significant fibrosis and cirrhosis in patients with bleeding disorders and hepatitis C detected by LSM, with considerable impact on the management of the disease.
Collapse
Affiliation(s)
- D Posthouwer
- Van Creveldkliniek, University Medical Utrecht, Utrecht, the Netherlands
| | | | | | | | | |
Collapse
|
42
|
Posthouwer D, Fischer K, De Heusden N, Mauser-Bunschoten EP. Pegylated interferon and ribavirin combination therapy for chronic hepatitis C in patients with congenital bleeding disorders: a single-centre experience. Haemophilia 2007; 13:98-103. [PMID: 17212733 DOI: 10.1111/j.1365-2516.2006.01404.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Chronic hepatitis C is a major comorbidity in patients with haemophilia. Although the current state-of-the-art therapy consists of pegylated interferon (PegIFN) and ribavirin, there are no reports of the efficacy of this combination in the haemophilia population. The aim of this study was to assess the response and side-effects of PegIFN and ribavirin in patients with inherited bleeding disorders. Patients with chronic hepatitis C were treated with PegIFN alpha-2b (1.5 microg kg(-1) week(-1)) and ribavirin (800-1200 mg day(-1)) for 24 (genotype 2 and 3) or 48 weeks (genotype 1) and followed for an additional 24 weeks. In total, 56 patients were enrolled: 31 (55%) had genotype 1, 12 (21%) genotype 2, and 13 (23%) genotype 3. Ten patients (18%) were HIV co-infected and seven (13%) had been previously treated with IFN-alpha with or without ribavirin. The overall response was 55%. In HIV-negative and treatment-naïve patients, the sustained virological response was 70%. Successful treatment was associated with genotypes 2 and 3, absence of HIV, absence of previous IFN treatment, and decrease of hepatitis C virus load at weeks 4 and 12. Although many side-effects occurred, only a minority (11%) discontinued therapy for this reason. Dose reduction of PegIFN was required in 28% and of ribavirin in 35% of patients. Overall, 22% of patients developed a depression requiring antidepressant drugs and one patient developed psychosis. In conclusion, PegIFN and ribavirin is effective in patients with inherited bleeding disorders. Treatment is safe, but severe side-effects may occur and warrant close monitoring during therapy.
Collapse
Affiliation(s)
- D Posthouwer
- Van Creveldkliniek, University Medical Center Utrecht, The Netherlands
| | | | | | | |
Collapse
|
43
|
Posthouwer D, Fischer K, van Erpecum KJ, Mauser-Bunschoten EP. The natural history of childhood-acquired hepatitis C infection in patients with inherited bleeding disorders. Transfusion 2006; 46:1360-6. [PMID: 16934072 DOI: 10.1111/j.1537-2995.2006.00903.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although many patients with inherited bleeding disorders have been infected with hepatitis C in early childhood, the natural history of infection in this patient group remains poorly defined. STUDY DESIGN AND METHODS A total of 212 patients with inherited bleeding disorders born between 1976 and 1992 were evaluated for hepatitis C virus (HCV) infection, spontaneous clearance, and (by noninvasive tests) progressive liver disease. RESULTS A total of 120 of 212 patients had been exposed to non-HCV-inactivated clotting products, and 68 of these 120 patients (57%) were anti-HCV-positive. Of these patients, 44 (65%) had chronic hepatitis C (HCV RNA-positive) and 24 (35%) showed spontaneous clearance (HCV RNA-negative). Five patients with hepatitis C were coinfected with hepatitis B virus and/or human immunodeficiency virus (HIV). Multivariate analysis indicated that hepatitis C infection was independently associated with longer treatment period (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3-1.9) and exposure to a larger number of donors (OR, 2.1; 95% CI, 1.1-3.9). Spontaneous HCV clearance was associated with a younger age at first exposure to clotting product (p = 0.02). After a mean infection period of 21 years, evidence of cirrhosis was present in 2 patients (5%), both of whom were coinfected with HIV. CONCLUSION Spontaneous HCV clearance is associated with young age at infection. Despite frequent childhood-acquired hepatitis C infection among patients with inherited bleeding disorders, progression to cirrhosis after 21 years of infection is rare. The diagnosis of cirrhosis without biopsy, however, remains challenging in this population, and new, noninvasive means must be developed to accurately identify cirrhotic patients.
Collapse
Affiliation(s)
- Dirk Posthouwer
- Van Creveldkliniek, the Julius Center for Health Sciences and Primary Care, and the Department of Gastroenterology, University Medical Center, Utrecht, the Netherlands.
| | | | | | | |
Collapse
|
44
|
Abstract
Chronic hepatitis C is a major cause of morbidity and mortality in haemophilia patients. In contrast to studies in the general population, the studies of antiviral therapy in haemophilia patients are limited and often include small numbers of patients. A review of the literature was performed to assess the efficacy of interferon (IFN)-based therapy for patients with haemophilia chronically infected with hepatitis C virus (HCV). Studies were identified by electronic searches (Medline, Embase) and hand searches in references of key articles. Data of the included studies were pooled, and responses to therapy were stratified according to treatment regimen, HIV co-infection status, and treatment history. The main outcome was a sustained virological response (SVR) defined as absence of HCV RNA both at the end of treatment and 24-week post-treatment. Thirty-five studies were identified that included 1151 patients. After pooling the data of included patients, the SVR in HIV-negative treatment naïve patients was 22% for IFN monotherapy, 43% for IFN and ribavirin, and 57% for pegylated IFN and ribavirin, respectively. Re-treatment with IFN and ribavirin of those who failed to respond to previous IFN monotherapy was successful in 33%. In HCV/HIV-coinfected patients, response to IFN monotherapy was 8% and to IFN combined with ribavirin 39%. Responses to IFN-based therapy in patients with haemophilia have been improved over time and are nowadays approximately 50-60%. However, data on haemophilic HCV/HIV-coinfected patients and in patients who failed to respond to previous therapy are limited and future studies in these specific patient population are necessary.
Collapse
Affiliation(s)
- D Posthouwer
- Van Creveldkliniek, University Medical Center, Utrecht, The Netherlands.
| | | | | | | |
Collapse
|
45
|
Plug I, Mauser-Bunschoten EP, Bröcker-Vriends AHJT, van Amstel HKP, van der Bom JG, van Diemen-Homan JEM, Willemse J, Rosendaal FR. Bleeding in carriers of hemophilia. Blood 2006; 108:52-6. [PMID: 16551972 DOI: 10.1182/blood-2005-09-3879] [Citation(s) in RCA: 218] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A wide range of factor VIII and IX levels is observed in heterozygous carriers of hemophilia as well as in noncarriers. In female carriers, extreme lyonization may lead to low clotting factor levels. We studied the effect of heterozygous hemophilia carriership on the occurrence of bleeding symptoms. A postal survey was performed among most of the women who were tested for carriership of hemophilia in the Netherlands before 2001. The questionnaire included items on personal characteristics, characteristics of hemophilia in the affected family members, and carrier testing and history of bleeding problems such as bleeding after tooth extraction, bleeding after tonsillectomy, and other operations. Information on clotting factor levels was obtained from the hospital charts. Logistic regression was used to assess the relation of carrier status and clotting factor levels with the occurrence of hemorrhagic events. In 2004, 766 questionnaires were sent, and 546 women responded (80%). Of these, 274 were carriers of hemophilia A or B. The median clotting factor level of carriers was 0.60 IU/mL (range, 0.05-2.19 IU/mL) compared with 1.02 IU/mL (range, 0.45-3.28 IU/mL) in noncarriers. Clotting factor levels from 0.60 to 0.05 IU/mL were increasingly associated with prolonged bleeding from small wounds and prolonged bleeding after tooth extraction, tonsillectomy, and operations. Carriers of hemophilia bleed more than other women, especially after medical interventions. Our findings suggest that not only clotting factor levels at the extreme of the distribution, resembling mild hemophilia, but also mildly reduced clotting factor levels between 0.41 and 0.60 IU/mL are associated with bleeding.
Collapse
Affiliation(s)
- Iris Plug
- Leinden Unversity Medical Center, Clinical Epidemiology, Leiden, Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Plug I, Van Der Bom JG, Peters M, Mauser-Bunschoten EP, De Goede-Bolder A, Heijnen L, Smit C, Willemse J, Rosendaal FR. Mortality and causes of death in patients with hemophilia, 1992-2001: a prospective cohort study. J Thromb Haemost 2006; 4:510-6. [PMID: 16460432 DOI: 10.1111/j.1538-7836.2006.01808.x] [Citation(s) in RCA: 223] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clotting factor products have been safe for HIV since 1985, and for hepatitis C since 1992. Few studies have reported on mortality in the total population of hemophilia patients after the period of risk of viral infection transmission. OBJECTIVES We studied the mortality, causes of death, and life expectancy of hemophilia patients between 1992 and 2001. We compared these findings with those of previous cohorts, together spanning the periods before, during, and after the use of potentially contaminated clotting products. PATIENTS AND METHODS We performed a prospective cohort study among 967 patients with hemophilia A and B. Death rates, overall and cause-specific, were compared with national mortality figures for males adjusted for age and calendar period as standardized mortality ratio (SMRs). RESULTS Between 1992 and 2001, 94 (9.7%) patients had died and two patients were lost to follow-up (0.2%). Mortality was 2.3-times higher in hemophilia patients than in the general male population (SMR 2.3 95% confidence interval 1.9-2.8). In patients with severe hemophilia, life expectancy decreased from 63 (1972-1985) to 59 years (1992-2001). Exclusion of virus-related deaths resulted in a life expectancy at birth of 72 years. CONCLUSIONS AIDS was the main cause of death (26%) and 22% of deaths were because of hepatitis C. In patients not affected by viral infections, there still appeared to be a trend toward a moderately increased mortality compared with the Dutch male population. Thus, mortality of patients with hemophilia is still increased; this is largely because of the consequences of viral infections.
Collapse
Affiliation(s)
- I Plug
- Leiden University Medical Center, Clinical Epidemiology, Leiden, the Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
|
48
|
Posthouwer D, Plug I, van der Bom JG, Fischer K, Rosendaal FR, Mauser-Bunschoten EP. Hepatitis C and health-related quality of life among patients with hemophilia. Haematologica 2005; 90:846-50. [PMID: 15951299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Hepatitis C has a negative effect on health-related quality of life (HRQoL). It is not clear whether hepatitis C affects HRQoL of patients with hemophilia. The objective of this study was to assess the effect of hepatitis C virus (HCV) infection on HRQoL in patients with hemophilia. A cross-sectional study was performed among all registered hemophilia patients in the Netherlands. HRQoL was determined by using the self-administered SF-36 questionnaire. Patients were eligible for the study if they completed the SF-36, had been treated with clotting factor products before 1992, and had reported their hepatitis C status. Data on the severity of hemophilia were obtained from the hemophilia treatment centers. The validity of the self-reported data on hepatitis C status was verified in a random sample of 92 (15%) patients; 92% reported their hepatitis C status correctly. Fifty-five percent (333/602) of the study population had a current HCV infection. All eight domains of the SF-36 were lower in patients with a current HCV infection than they were in patients who had never been infected with HCV. After adjustment for age, severity of hemophilia, human immunodeficiency virus (HIV) status, employment status, and joint limitations, hepatitis C infection was associated with a decrease of HRQoL on the domains of general health (difference 6.9 [95% confidence interval (C.I.) 2.7 to 11.2]) and vitality (3.8 [95% C.I. 0.1 to 7.7]). Hemophilia patients infected with HCV scored lower on the HRQoL domains of general health and vitality than hemophilia patients who had never been infected with HCV.
Collapse
Affiliation(s)
- Dirk Posthouwer
- Van Creveldkliniek, University Medical Center Utrecht, Heidelberglaan 100, C.01.425, 3508 GA, Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
49
|
Fischer K, Bom JG, Mauser-Bunschoten EP, Roosendaal G, Berg HM. Effects of haemophilic arthropathy on health-related quality of life and socio-economic parameters. Haemophilia 2005; 11:43-8. [PMID: 15660988 DOI: 10.1111/j.1365-2516.2005.01065.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although prophylactic treatment is advised for all children with severe haemophilia, the optimal regimen is still under discussion. Should all joint bleeds be prevented, or can a limited amount of arthropathy be tolerated in adulthood without loss of quality of life? To answer this question, the effect of haemophilic arthropathy on health-related quality of life (HRQoL) needs to be quantified. In a retrospective study, the effect of arthropathy on HRQoL and socio-economic parameters was assessed in a single-centre cohort of 96 patients with severe and moderate haemophilia with a minimum age of 13 years. Arthropathy was measured by the radiological Pettersson score of the elbows, knees and ankles (maximum: 78 points). HRQoL was assessed by the Short Form 36 (SF36), measuring eight domains of health. Labourforce participation and medical consumption were assessed using a separate questionnaire. Patients were studied at a mean age of 28.6 years (range: 13-54), the mean time between evaluation and the last Pettersson score was 0.4 years (SD: 1.1). The overall median Pettersson score was 13 (range: 0-78). There was a trend towards lower quality of life with increasing Pettersson scores and age, especially in the physical domains of the SF36. An age-adjusted analysis showed that arthropathy had a small but significant effect on HRQoL in the domain of 'physical function' of the SF36, but not on its other domains, or on labourforce participation and medical consumption. Thus suggesting that the SF36 can be used to assess the effects of haemophilic arthropathy, especially in the domain of 'physical function'.
Collapse
Affiliation(s)
- K Fischer
- Department of Paediatrics, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|
50
|
Posthouwer D, Plug I, van der Bom JG, Fischer K, Rosendaal FR, Mauser-Bunschoten EP. Hepatitis C infection among Dutch haemophilia patients: a nationwide cross-sectional study of prevalence and antiviral treatment. Haemophilia 2005; 11:270-5. [PMID: 15876273 DOI: 10.1111/j.1365-2516.2005.01083.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hepatitis C is a major co-morbidity among patients with haemophilia who received inadequately or non-virus-inactivated clotting factor concentrates before 1992. The objectives of this study were to investigate the prevalence of hepatitis C and the use of antiviral therapies during the last decade among patients with haemophilia in the Netherlands. We performed a cross-sectional study and a questionnaire was sent to all 1519 patients known with haemophilia in the Netherlands between 2001 and 2002. The study population for the present study consisted of 771 patients who had received clotting factor products before 1992 of whom 638 reported their hepatitis C status. In total, 441 of the 638 (68%) patients ever had a positive test for hepatitis C virus (HCV); 344 patients (54%) had a current infection, and 97 (15%) had cleared the virus. Among 344 patients currently HCV infected, 111 (32%) had received treatment for hepatitis C, while 34% (33/97) of patients with an infection in the past had been treated for hepatitis C. In 2002 the prevalence of hepatitis C among patients with haemophilia who received clotting factor products before 1992 was 54%. The majority of patients with a current HCV infection had not been treated with antiviral therapy.
Collapse
Affiliation(s)
- D Posthouwer
- Van Creveldkliniek, University Medical Center, Utrecht, the Netherlands.
| | | | | | | | | | | |
Collapse
|