Hospital Pharmacy-Clinical Pharmacology, Amsterdam University Medical Center, Noord-Holland, The Netherlands.
Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.
Thromb Haemost. 2023 Mar;123(3):317-325. doi: 10.1055/a-1983-0594. Epub 2022 Nov 19.
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.
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.
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.
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.
关于运动参与如何影响血友病患者的出血风险知之甚少。本研究旨在探讨运动参与、VIII 因子（FVIII）水平与血友病 A 患者出血之间的关系。
在这项观察性、前瞻性、单中心研究中，定期参加运动的血友病 A 患者接受了 12 个月的随访。通过重复时间事件建模分析患者特征、FVIII 水平以及运动参与的类型/频率与出血的关系。
共纳入 112 名患者（中位年龄：24 岁[四分位距：16-34]，49%为重度，49%接受预防治疗）。随访期间观察到 70 例出血，其中 20 例为运动相关出血。FVIII 水平与出血危险呈负相关；基线出血危险降低 50%时，FVIII 水平为 3.1IU/dL；降低 90%时，FVIII 水平为 28.0IU/dL。运动参与与出血危险无相关性。此外，重度血友病、研究前每年出血率和关节病的存在与出血危险呈正相关。
本分析表明，FVIII 水平是出血危险的重要决定因素，但运动参与不是。这一观察结果最有可能反映了我们研究中运动参与期间 FVIII 水平充足。重度血友病 A 患者在类似 FVIII 水平下表现出更高的出血危险，这表明处于较低 FVIII 水平的时间会影响整体出血危险。这些数据可用于就运动参与和充分预防治疗的必要性为血友病患者提供咨询。
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