PB0676 - Risk factors for bleeding in people living with Hemophilia A and B treated with regular prophylaxis: a systematic review of the literature.

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Co-Author(s)

FG

Federico Germini

Assistant Professor
Department of Medicine, McMaster University, Hamilton, ON
Hamilton, Ontario, Canada
NN

Noella Noronha

Research Assistant
McMaster University
Hamilton, Ontario, Canada
AB

Abraham Philip Binu

Research Assistant
McMaster University
Hamilton, Ontario, Canada
OO

Omotola Olasupo

PhD Candidate
McMaster University
Hamilton, Ontario, Canada
DP

Drashti Pete

Research Assistant
McMaster University
Hamilton, Ontario, Canada
TN

Tamara Navarro

Research Coordinator
McMaster University
Hamilton, Ontario, Canada
AK

Arun Keepanasseril

Assistant Professor
Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada
Hamilton, Ontario, Canada

Presenting Author(s)

Davide Matino, MD

Assistant Professor
Department of Medicine, Division of Hematology, McMaster University, Hamilton, ON
Hamilton, Ontario, Canada

Co-Author(s)

Kerstin de Wit, MBChB, MSc, MD, MRCP, FRCEM, FRCPC

Associate Professor
Department of Emergency Medicine, Queen’s University
Kingston, Ontario, Canada
SP

Sameer Parpia

Associate Professor and Biostatistician
Department of Health Research Methods, Evidence, & Impact, McMaster University
Hamilton, Ontario, Canada
AI

Alfonso Iorio

Professor
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
Hamilton, Ontario, Canada

Background: Knowledge about the risk for bleeding in patients with hemophilia (PWH) would be relevant for patients, stakeholders, and policymakers.

Aims: Our objectives were to perform a systematic review of the literature on 1) risk assessment models (RAMs) and 2) risk factors for bleeding in PWH on regular prophylaxis.

Methods: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from inception through August 2019. In duplicate, reviewers screened the articles for inclusion, extracted data, and assessed the risk for bias using the QUIPS tool. A qualitative synthesis of the results was performed due to high heterogeneity in risk factors, outcomes definition and measurement, and statistical analysis of the results.

Results: From 1843 search results, 10 studies met the inclusion criteria. The characteristics of the included studies are reported in Table 1. No RAM for the risk for bleeding in PWH was found. Most studies included only PWH A or both PWH A and B and were conducted in North America or Europe. Only one study had a low risk for bias in all the domains. The risk factors, outcome definitions, risk estimates, and confounders considered in the analyses are reported in Table 2. Eight categories of risk factors were identified. The risk for bleeding was increased when factor levels were lower and in people with a significant history of bleeding or who engaged in physical activities involving contact.

Conclusion(s): Increased plasma factor levels, history of previous bleeds, and physical activity are relevant risk factors for bleeding. These risk factors should be included while building a RAM, and the role of other risk factors should be explored.