Professor Children's Hospital Colorado Aurora, Colorado, United States
Background: Increasing numbers of biological females with inherited bleeding disorders (IBD)s are seeking care at Hemophilia Treatment Centers (HTC)s. Clinicians face a growing need for guidance in the use of hemostatic therapies in such patients, particularly those with competing age-associated vascular risk factors.
Aims: This study will report the frequency of bleeding and arterial vascular events in post-menopausal biological females with IBDs to inform practitioners who make treatment decisions for this population.
Methods: This study was funded by a Women’s Health Research Seed grant and was approved by institutional IRB. Biological females over 45 years who had undergone menopause or had an FSH of >30mlU/mL were recruited from the University of Colorado’s HTC. Consenting subjects participated in a guided telephone survey conducted by the primary investigator.
Results: Thirty-five biological females with an average age of 64.29 years participated. The most common inherited bleeding disorder diagnoses were von Willebrand Disease (N = 13), heterozygous hemophilia A (N = 10), and heterozygous hemophilia B (N = 6).
Eight biological females (22.86%) experienced post-menopausal vaginal bleeding. Over two thirds of subjects (N = 27, 77.14%) reported non-vaginal bleeding after menopause, with bleeding associated with invasive procedures being most common (N = 18, 66.67%) (TABLE 1).
Three subjects experienced a stroke or myocardial infarction. Four subjects each were treated with aspirin and/or anticoagulation. All patients treated with anticoagulation experienced an adverse bleeding event while on treatment (TABLE 2).
Conclusion(s): Although this data is limited by a small sample size and biased towards patients with more severe phenotypes, it is notable that post-menopausal bleeding, in particular surgical bleeding, remains common despite the competing vascular risk factors and rising von Willebrand Factor and Factor VIII activity levels that accompany increasing age. These results underscore the need for strategies to individualize hemostatic therapies in older biological females with IBDs.
