Bleeding Prevalence Higher with Hemophilia, But Data Unclear on Arterial Thrombosis

The prevalence of hemorrhagic stroke, intracranial hemorrhage, and gastrointestinal bleeding was consistently higher in people with hemophilia compared with people without the disorder, according to a scoping review published online in Research and Practice in Thrombosis and Haemostasis. 

“Serious bleeding events showed a high rate of mortality,” wrote corresponding author Amy D. Shapiro, MD, of the Indiana Hemophilia and Thrombosis Center in Indianapolis, and coauthors, “with standardized mortality ratios for intracranial hemorrhage ranging from 3.5 to 14.88.”

The review included 83 studies with data on bleeding and thrombotic events in people with hemophilia compared with the general population.

The prevalence of selected bleeding events—hemorrhagic stroke, intracranial hemorrhage, and gastrointestinal bleeding—was frequently higher in hemophilia populations. According to the study, hemorrhagic stroke had a prevalence of 1.4% to 5.31% in people with hemophilia compared with 0.2% to 0.97% in reference populations. Intracranial hemorrhage had a prevalence of 1.1% to 10.8% in those with hemophilia compared with 0.04% to 0.4% in reference populations. In one study, the prevalence of upper gastrointestinal bleeding associated with Helicobacter pylori infection was 31.5% in people with hemophilia and compared with just 2% in the general population.

In people with hemophilia, intracranial hemorrhage remained a severe bleeding event that resulted in high mortality, researchers reported.

The review also found that people with hemophilia had a lower prevalence of arterial thrombosis compared with the general population in nine studies. However, five other studies showed a comparable to higher prevalence of arterial thrombosis in people with hemophilia. 

“Patients with hemophilia had a slightly reduced prevalence of venous thrombosis than the general population, which is in agreement with the data from a previous study that suggested that persons with hemophilia may potentially exhibit some protection from venous thrombosis, but not arterial thrombosis,” researchers wrote. “However, the paucity of data makes these comparisons difficult, and more research is needed to understand these differences.”
 

Reference:
Shapiro AD, Hardesty BM, Peyvandi F, Iorio A. Prevalence of selected bleeding and thrombotic events in persons with hemophilia versus the general population: a scoping review. Res Pract Thromb Haemost. 2022;7(1):100007. doi:10.1016/j.rpth.2022.100007