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CC BY 4.0 · Thromb Haemost 2023; 123(03): 317-325
DOI: 10.1055/a-1983-0594
Coagulation and Fibrinolysis

Association between Sports Participation, Factor VIII Levels and Bleeding in Hemophilia A

Laura H. Bukkems 
1   Hospital Pharmacy-Clinical Pharmacology, Amsterdam University Medical Center, Noord-Holland, The Netherlands
,
Olav Versloot 
2   Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
3   Department of Physiotherapy, Institute of Movement Studies, University of Applied Science, Utrecht, The Netherlands
,
Marjon H. Cnossen
4   Department of Pediatric Hematology and Oncology, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
,
Siv Jönsson 
5   Department of Pharmacy, Uppsala University, Uppsala, Sweden
,
Mats O. Karlsson
5   Department of Pharmacy, Uppsala University, Uppsala, Sweden
,
Ron A.A. Mathôt
1   Hospital Pharmacy-Clinical Pharmacology, Amsterdam University Medical Center, Noord-Holland, The Netherlands
,
Kathelijn Fischer
2   Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
› Author Affiliations Funding This study was funded by Bayer. L.H.B is funded by the OPTI-CLOT/To-WiN studies and the SYMPHONY consortium. The SYMPHONY consortium aims to orchestrate personalized treatment in people with bleeding disorders, and is a unique collaboration between patients, health care professionals, and translational and fundamental researchers specialized in inherited bleeding disorders, as well as experts from multiple disciplines. It aims to identify the best treatment choice for each individual based on bleeding phenotype. In order to achieve this goal, workpackages have been organized according to three themes, e.g. Diagnostics (workpackage 3 and 4); Treatment (workpackages 5–9), and Fundamental Research (workpackages 10–12). This research received funding from the Netherlands Organization for Scientific Research (NWO) in the framework of the NWA-ORC Call grant agreement NWA.1160.18.038. Principal investigator: Dr. M. H. Cnossen; project coordinator: Dr. S. H. Reitsma.
Beneficiaries of the SYMPHONY consortium: Erasmus University Medical Center-Sophia Children's Hospital, project leadership and coordination; Sanquin Diagnostics; Sanquin Research; Amsterdam University Medical Centers; University Medical Center Groningen; University Medical Center Utrecht; Leiden University Medical Center; Radboud University Medical Center; Netherlands Society of Hemophilia Patients (NVHP); Netherlands Society for Thrombosis and Hemostasis (NVTH); Bayer B.V., CSL Behring B.V., and Swedish Orphan Biovitrum (Belgium) BVBA/SPRL.
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Abstract

Background Little is known on how sports participation affects bleeding risk in hemophilia. This study aimed to examine associations between sports participation, factor VIII (FVIII) levels and bleeding in persons with hemophilia A.

Methods In this observational, prospective, single-center study, persons with hemophilia A who regularly participated in sports were followed for 12 months. The associations of patient characteristics, FVIII levels, and type/frequency of sports participation with bleeding were analyzed by repeated time-to-event modelling.

Results One hundred and twelve persons (median age: 24 years [interquartile range:16–34], 49% severe, 49% on prophylaxis) were included. During follow-up, 70 bleeds of which 20 sports-induced were observed. FVIII levels were inversely correlated with the bleeding hazard; a 50% reduction of the baseline bleeding hazard was observed at FVIII levels of 3.1 and a 90% reduction at 28.0 IU/dL. The bleeding hazard did not correlate with sports participation. In addition, severe hemophilia, prestudy annual bleeding rate, and presence of arthropathy showed a positive association with the bleeding hazard.

Conclusion This analysis showed that FVIII levels were an important determinant of the bleeding hazard, but sports participation was not. This observation most likely reflects the presence of adequate FVIII levels during sports participation in our study. Persons with severe hemophilia A exhibited a higher bleeding hazard at a similar FVIII levels than nonsevere, suggesting that the time spent at lower FVIII levels impacts overall bleeding hazard. These data may be used to counsel persons with hemophilia regarding sports participation and the necessity of adequate prophylaxis.

Keywords

bleeding - hemophilia A - prophylaxis - repeated time-to-event - sports

Supplementary Material



Publication History

Received: 04 July 2022

Accepted: 20 October 2022

Accepted Manuscript online:
19 November 2022

Article published online:
31 December 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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