Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Institute of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria. Electronic address: https://twitter.com/dino_mehic.
Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
J Thromb Haemost. 2023 Jul;21(7):1757-1768. doi: 10.1016/j.jtha.2023.03.006. Epub 2023 Mar 15.
The future bleeding risk, especially after hemostatic challenges, and thus the requirement for hemostatic treatment in patients with mild-to-moderate bleeding disorders (MBDs) is largely unknown.
This study aimed to prospectively examine the recurrence of bleeding symptoms and clinical risk factors for future bleeding in patients with MBD, including patients with bleeding disorder of unknown cause (BDUC).
Bleeding symptoms of patients with MBD included in the Vienna Bleeding Biobank were re-evaluated at in-person follow-up visits or by mail.
In total, 392 patients, including 62.8% with BDUC, were investigated for the recurrence of bleeding events. During the follow-up time of median (IQR) 4.3 years (2.6-6.7), 72% of patients had at least 1 bleeding event. Most persistent bleeding manifestations were hematomas (n = 146/245, 59.6%) and bleeding from small wounds (n = 69/141, 48.9%), followed by epistaxis (n = 42/132, 31.8%), oral mucosal bleeding (n = 26/87, 29.9%), and joint bleeding (n = 7/14, 50.0%). Patients with previous postinterventional bleeding had a significantly increased risk for bleeding events after surgery (n = 33/114, 29.0 %) or tooth extraction (n = 16/39, 41.0%). A high bleeding score (OR [95% CI], 1.14 [1.05 to 2.94], per 1 unit) and follow-up time (OR [95% CI], 1.23 [1.12 to 1.36], per 1 year) were independently associated with any bleeding event. For bleeding after hemostatic challenges, blood group O (OR, 3.17 [1.57 to 6.40]), previous postsurgical bleeding (OR, 2.40 [1.06 to 5.46]), and an established diagnosis (OR, 2.07 [1.04 to 4.10]) were independent risk factors.
Patients with MBD have a high risk for recurrent bleeding. This encourages prophylactic hemostatic treatment in patients with MBD, particularly when they face hemostatic challenges.
对于轻度至中度出血性疾病（MBD）患者，尤其是在止血治疗后，未来出血的风险，以及因此对止血治疗的需求在很大程度上是未知的。
本研究旨在前瞻性地检查 MBD 患者复发出血症状和未来出血的临床危险因素，包括原因不明的出血性疾病（BDUC）患者。
在维也纳出血生物库中纳入的 MBD 患者的出血症状在面对面随访或通过邮件进行重新评估。
共调查了 392 例患者，其中 62.8%为 BDUC 患者，以评估出血事件的复发情况。在中位数（IQR）4.3 年（2.6-6.7）的随访期间，72%的患者至少有 1 次出血事件。最常见的持续性出血表现为血肿（n=146/245，59.6%）和小伤口出血（n=69/141，48.9%），其次是鼻出血（n=42/132，31.8%）、口腔黏膜出血（n=26/87，29.9%）和关节出血（n=7/14，50.0%）。有既往介入后出血的患者在接受手术（n=33/114，29.0%）或拔牙（n=16/39，41.0%）后发生出血事件的风险显著增加。较高的出血评分（OR[95%CI]，1.14[1.05-2.94]，每增加 1 个单位）和随访时间（OR[95%CI]，1.23[1.12-1.36]，每增加 1 年）与任何出血事件独立相关。对于止血治疗后的出血，血型 O（OR，3.17[1.57-6.40]）、既往术后出血（OR，2.40[1.06-5.46]）和已确诊的疾病（OR，2.07[1.04-4.10]）是独立的危险因素。
MBD 患者有复发出血的高风险。这鼓励对 MBD 患者进行预防性止血治疗，尤其是当他们面临止血挑战时。
