Mortality caused by intracranial bleeding in non‐severe hemophilia A patients

• Published in: Journal of thrombosis and haemostasis 2017-06, Vol.15 (6), p.1115-1122
• Main Authors: Loomans, J. I., Eckhardt, C. L., Reitter‐Pfoertner, S. E., Holmström, M., Gorkom, B. Laros, Leebeek, F. W. G., Santoro, C., Haya, S., Meijer, K., Nijziel, M. R., Bom, J. G., Fijnvandraat, K.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Australia; Bats; Bleeding; Child; Child, Preschool; Coagulation factors; Cohort Studies; cohort study; Comorbidity; Data processing; Death; Death & dying; Drugs; epidemiology; Europe; Factor VIII - therapeutic use; Factor VIII deficiency; Hemophilia; hemophilia A; Hemophilia A - complications; Hemophilia A - drug therapy; Hemophilia A - mortality; Hemorrhage - drug therapy; Humans; Infant; Infant, Newborn; International Cooperation; intracranial hemorrhage; Intracranial Hemorrhages - complications; Intracranial Hemorrhages - mortality; Male; Medicin och hälsovetenskap; Middle Aged; Mortality; Phenotype; Population; Recombinant Proteins - therapeutic use; Risk Factors; Young Adult
• ISSN: 1538-7933; 1538-7836; 1538-7836
• DOI: 10.1111/jth.13693

Essentials Data on bleeding‐related causes of death in non‐severe hemophilia A (HA) patients are scarce. Such data may provide new insights into areas of care that can be improved. Non‐severe HA patients have an increased risk of dying from intracranial bleeding. This demonstrates the need for specialized care for non‐severe HA patients. Summary Background Non‐severe hemophilia (factor VIII concentration [FVIII:C] of 2–40 IU dL−1) is characterized by a milder bleeding phenotype than severe hemophilia A. However, some patients with non‐severe hemophilia A suffer from severe bleeding complications that may result in death. Data on bleeding‐related causes of death, such as fatal intracranial bleeding, in non‐severe patients are scarce. Such data may provide new insights into areas of care that can be improved. Aims To describe mortality rates, risk factors and comorbidities associated with fatal intracranial bleeding in non‐severe hemophilia A patients. Methods We analyzed data from the INSIGHT study, an international cohort study of all non‐severe hemophilia A patients treated with FVIII concentrates during the observation period between 1980 and 2010 in 34 participating centers across Europe and Australia. Clinical data and vital status were collected from 2709 patients. We report the standardized mortality rate for patients who suffered from fatal intracranial bleeding, using a general European male population as a control population. Results Twelve per cent of the 148 deceased patients in our cohort of 2709 patients died from intracranial bleeding. The mortality rate between 1996 and 2010 for all ages was 3.5‐fold higher than that in the general population (95% confidence interval [CI] 2.0–5.8). Patients who died from intracranial bleeding mostly presented with mild hemophilia without clear comorbidities. Conclusion Non‐severe hemophilia A patients have an increased risk of dying from intracranial bleeding in comparison with the general population. This demonstrates the need for specialized care for non‐severe hemophilia A patients.